Method of Surgical Stapling with End Effector Component Having a Curved Tip

ABSTRACT

A method of surgical stapling that uses a surgical instrument operable to compress, staple, and cut tissue. The instrument includes a body, a shaft, and an end effector with a pair of jaws. A placement tip extends distally from one of the jaws of the end effector. The method includes positioning the end effector at a desired site for surgical stapling. The method also includes controlling one or more of the jaws of the end effector to place the end effector in an open position. The method also includes positioning the end effector such that tissue is located between the jaws. The method also includes clamping the tissue between the jaws by moving at least one of the jaws toward the other jaw. The method also includes advancing a firing beam of the apparatus from a proximal position to a distal position.

PRIORITY

This application is a continuation-in-part of U.S. Non-Provisionalpatent application Ser. No. 15/435,573, filed Feb. 17, 2017, entitled“SURGICAL STAPLER WITH ELASTICALLY DEFORMABLE TIP,” the disclosure ofwhich is incorporated by reference herein.

BACKGROUND

In some settings, endoscopic surgical instruments may be preferred overtraditional open surgical devices since a smaller incision may reducethe post-operative recovery time and complications. Consequently, someendoscopic surgical instruments may be suitable for placement of adistal end effector at a desired surgical site through the cannula of atrocar. These distal end effectors may engage tissue in a number of waysto achieve a diagnostic or therapeutic effect (e.g., endocutter,grasper, cutter, stapler, clip applier, access device, drug/gene therapydelivery device, and energy delivery device using ultrasound, RF, laser,etc.). Endoscopic surgical instruments may include a shaft between theend effector and a handle portion, which is manipulated by theclinician. Such a shaft may enable insertion to a desired depth androtation about the longitudinal axis of the shaft, thereby facilitatingpositioning of the end effector within the patient. Positioning of anend effector may be further facilitated through inclusion of one or morearticulation joints or features, enabling the end effector to beselectively articulated or otherwise deflected relative to thelongitudinal axis of the shaft.

Examples of endoscopic surgical instruments include surgical staplers.Some such staplers are operable to clamp down on layers of tissue, cutthrough the clamped layers of tissue, and drive staples through thelayers of tissue to substantially seal the severed layers of tissuetogether near the severed ends of the tissue layers. Merely exemplarysurgical staplers are disclosed in U.S. Pat. No. 4,805,823, entitled“Pocket Configuration for Internal Organ Staplers,” issued Feb. 21,1989; U.S. Pat. No. 5,415,334, entitled “Surgical Stapler and StapleCartridge,” issued May 16, 1995; U.S. Pat. No. 5,465,895, entitled“Surgical Stapler Instrument,” issued Nov. 14, 1995; U.S. Pat. No.5,597,107, entitled “Surgical Stapler Instrument,” issued Jan. 28, 1997;U.S. Pat. No. 5,632,432, entitled “Surgical Instrument,” issued May 27,1997; U.S. Pat. No. 5,673,840, entitled “Surgical Instrument,” issuedOct. 7, 1997; U.S. Pat. No. 5,704,534, entitled “Articulation Assemblyfor Surgical Instruments,” issued Jan. 6, 1998; U.S. Pat. No. 5,814,055,entitled “Surgical Clamping Mechanism,” issued Sep. 29, 1998; U.S. Pat.No. 6,978,921, entitled “Surgical Stapling Instrument Incorporating anE-Beam Firing Mechanism,” issued Dec. 27, 2005; U.S. Pat. No. 7,000,818,entitled “Surgical Stapling Instrument Having Separate Distinct Closingand Firing Systems,” issued Feb. 21, 2006; U.S. Pat. No. 7,143,923,entitled “Surgical Stapling Instrument Having a Firing Lockout for anUnclosed Anvil,” issued Dec. 5, 2006; U.S. Pat. No. 7,303,108, entitled“Surgical Stapling Instrument Incorporating a Multi-Stroke FiringMechanism with a Flexible Rack,” issued Dec. 4, 2007; U.S. Pat. No.7,367,485, entitled “Surgical Stapling Instrument Incorporating aMultistroke Firing Mechanism Having a Rotary Transmission,” issued May6, 2008; U.S. Pat. No. 7,380,695, entitled “Surgical Stapling InstrumentHaving a Single Lockout Mechanism for Prevention of Firing,” issued Jun.3, 2008; U.S. Pat. No. 7,380,696, entitled “Articulating SurgicalStapling Instrument Incorporating a Two-Piece E-Beam Firing Mechanism,”issued Jun. 3, 2008; U.S. Pat. No. 7,404,508, entitled “SurgicalStapling and Cutting Device,” issued Jul. 29, 2008; U.S. Pat. No.7,434,715, entitled “Surgical Stapling Instrument Having MultistrokeFiring with Opening Lockout,” issued Oct. 14, 2008; U.S. Pat. No.7,721,930, entitled “Disposable Cartridge with Adhesive for Use with aStapling Device,” issued May 25, 2010; U.S. Pat. No. 8,408,439, entitled“Surgical Stapling Instrument with An Articulatable End Effector,”issued Apr. 2, 2013; and U.S. Pat. No. 8,453,914, entitled “Motor-DrivenSurgical Cutting Instrument with Electric Actuator Directional ControlAssembly,” issued Jun. 4, 2013. The disclosure of each of theabove-cited U.S. Patents and U.S. Patent Publications is incorporated byreference herein.

While the surgical staplers referred to above are described as beingused in endoscopic procedures, it should be understood that suchsurgical staplers may also be used in open procedures and/or othernon-endoscopic procedures. By way of example only, a surgical staplermay be inserted through a thoracotomy and thereby between a patient'sribs to reach one or more organs in a thoracic surgical procedure thatdoes not use a trocar as a conduit for the stapler. Such procedures mayinclude the use of the stapler to sever and close a vessel leading to alung. For instance, the vessels leading to an organ may be severed andclosed by a stapler before removal of the organ from the thoraciccavity. Of course, surgical staplers may be used in various othersettings and procedures.

While various kinds of surgical stapling instruments and associatedcomponents have been made and used, it is believed that no one prior tothe inventor(s) has made or used the invention described in the appendedclaims.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated in and constitute apart of this specification, illustrate embodiments of the invention,and, together with the general description of the invention given above,and the detailed description of the embodiments given below, serve toexplain the principles of the present invention.

FIG. 1 depicts a perspective view of an exemplary articulating surgicalstapling instrument;

FIG. 2 depicts a side view of the instrument of FIG. 1;

FIG. 3 depicts a perspective view of an opened end effector of theinstrument of FIG. 1;

FIG. 4A depicts a side cross-sectional view of the end effector of FIG.3, taken along line 4-4 of FIG. 3, with the firing beam in a proximalposition;

FIG. 4B depicts a side cross-sectional view of the end effector of FIG.3, taken along line 4-4 of FIG. 3, with the firing beam in a distalposition;

FIG. 5 depicts an end cross-sectional view of the end effector of FIG.3, taken along line 5-5 of FIG. 3;

FIG. 6 depicts an exploded perspective view of the end effector of FIG.3;

FIG. 7 depicts a perspective view of the end effector of FIG. 3,positioned at tissue and having been actuated once in the tissue;

FIG. 8 depicts a perspective view of an alternative version of an endeffector with an angled anvil and an angled cartridge;

FIG. 9 depicts an enlarged, side view of the end effector of FIG. 8;

FIG. 10 depicts an enlarged top view of the end effector of FIG. 8;

FIG. 11 depicts a perspective view of an exemplary surgical staplinginstrument having an end effector with a bent or angled elasticallydeformable tip section;

FIG. 12A depicts an enlarged side view of a distal portion of the endeffector of FIG. 11;

FIG. 12B depicts an enlarged side view of a distal portion of analternate end effector similar to that of FIG. 11;

FIG. 13 depicts a bottom view of a distal portion of the end effector ofFIG. 11 with the cartridge shown in phantom to reveal an undersidesurface of the anvil;

FIG. 14 depicts a side cross-sectional view of a distal portion of theend effector of FIG. 11, taken along line 14-14 of FIG. 13;

FIG. 15 depicts an end cross-sectional view of an anvil the end effectorof FIG. 11, taken along line 15-15 of FIG. 13;

FIG. 16 depicts an enlarged side view of a distal portion of analternative version of an end effector, shown in an open position andhaving an upper jaw with a placement tip that forms a first angle with alongitudinal axis of the upper jaw;

FIG. 17 depicts an enlarged side view of the distal portion of the endeffector of

FIG. 16, shown in a closed position and having the placement tip forminga second angle with the longitudinal axis of the upper jaw;

FIG. 18 depicts an enlarged side view of a distal portion of analternative version of an end effector, shown in a closed and unloadedposition and having an upper jaw with placement tip that forms a firstangle with a nose portion of a lower jaw;

FIG. 19 depicts an enlarged side view of the distal portion of the endeffector of

FIG. 18, shown in a closed and loaded position and having the placementtip forming a second angle with the nose portion of the lower jaw;

FIG. 20 depicts an enlarged side view of a distal portion of analternative version of an end effector, shown in a closed position witha distal end of a placement tip of an upper jaw being located relativeto a deck and a distal end of a lower jaw;

FIG. 21 depicts an enlarged side view of a distal portion of analternative version of an end effector, shown in a closed position andwith zones defined by a lower jaw with a distal end of a placement tipof an upper jaw being located in a first zone;

FIG. 22A depicts an enlarged side view of a distal portion of analternative version of an end effector, shown in a closed position andwith a distal end of a placement tip of an upper jaw being located in athird zone as shown in FIG. 21;

FIG. 22B depicts an enlarged side view of a distal portion of analternative version of an end effector, shown in a closed position andwith a distal end of a curved placement tip of an upper jaw beinglocated in a third zone as shown in FIG. 21;

FIG. 22C depicts an enlarged side view of a distal portion of analternative version of an end effector, shown in a closed position andwith a distal end of a placement tip of an upper jaw being located in afourth zone as shown in FIG. 21;

FIG. 22D depicts an enlarged side view of a distal portion of analternative version of an end effector, shown in a closed position andwith a distal end of a curved placement tip of an upper jaw beinglocated in a fifth zone as shown in FIG. 21;

FIG. 22E depicts an enlarged side view of a distal portion of analternative version of an end effector, shown in a closed position andwith a distal end of a placement tip of an upper jaw being located in asixth zone as shown in FIG. 21;

FIG. 22F depicts an enlarged side view of a distal portion of analternative version of an end effector, shown in a closed position andwith a distal end of a multi-angled placement tip of an upper jaw beinglocated in a sixth zone as shown in FIG. 21;

FIG. 22G depicts an enlarged side view of a distal portion of analternative version of an end effector, shown in a closed position andwith a distal end of a placement tip of an upper jaw being located in athird zone as shown in FIG. 21, and the placement tip configured with aprofile of an underside surface that corresponds with a profile of ataper of the nose portion of a lower jaw;

FIG. 23A depicts an enlarged top view of a placement tip of analternative version of an end effector, with the placement tip having adistal end with a round profile;

FIG. 23B depicts an enlarged top view of a placement tip of analternative version of an end effector, with the placement tip having adistal end with an angled and pointed profile;

FIG. 23C depicts an enlarged top view of a placement tip of analternative version of an end effector, with the placement tip having adistal end with a toothed profile;

FIG. 23D depicts an enlarged top view of a placement tip of analternative version of an end effector, with the placement tip having adistal end with a flared profile;

FIG. 23E depicts an enlarged top view of a placement tip of analternative version of an end effector, with the placement tip having adistal end with an orb profile;

FIG. 23F depicts an enlarged top view of a placement tip of analternative version of an end effector, with the placement tip having adistal end with an asymmetric profile;

FIG. 24A depicts an enlarged top view of a placement tip of analternative version of an end effector, with the placement tip having awidth with an angled profile;

FIG. 24B depicts an enlarged top view of a placement tip of analternative version of an end effector, with the placement tip having awidth with a stepped profile;

FIG. 24C depicts an enlarged top view of a placement tip of analternative version of an end effector, with the placement tip having awidth with an asymmetric profile;

FIG. 24D depicts an enlarged top view of a placement tip of analternative version of an end effector, with the placement tip having awidth with a scallop tip-on-center profile;

FIG. 24E depicts an enlarged top view of a placement tip of analternative version of an end effector, with the placement tip having awidth with a bump-out profile;

FIG. 25 depicts an enlarged top view of a placement tip of analternative version of an end effector, with the placement tip having adistal end with an angled and pointed profile and with the placement tiphaving a width with an angled profile;

FIG. 26A depicts an enlarged side view of a distal portion of analternative version of an end effector, with a placement tip of an upperjaw having an underside surface with a flat profile parallel with aprofile of a nose portion of a lower jaw;

FIG. 26B depicts an enlarged side view of a distal portion of analternative version of an end effector, with a placement tip of an upperjaw having an underside surface with a curved profile;

FIG. 26C depicts an enlarged side view of a distal portion of analternative version of an end effector, with a straight placement tip ofan upper jaw having an underside surface with a flat profile;

FIG. 26D depicts an enlarged side view of a distal portion of analternative version of an end effector, with a placement tip of an upperjaw having an underside surface with a multi-angled profile;

FIG. 26E depicts an enlarged side view of a distal portion of analternative version of an end effector, with a placement tip of an upperjaw having an underside surface with a curved member and shown with theplacement tip in dual positions;

FIG. 27A depicts an enlarged side view of a distal portion of analternative version of an end effector, showing a gap between aplacement tip of an upper jaw and a nose portion of a lower jaw;

FIG. 27B depicts an enlarged side view of a distal portion of analternative version of an end effector, showing a smaller gap between adistal end of a placement tip of an upper jaw and a nose portion of alower jaw compared to the gap of FIG. 27A;

FIG. 28 depicts an enlarged perspective view of a distal portion of ajaw of an alternative version of an end effector;

FIG. 29 depicts a top view of the jaw of FIG. 28;

FIG. 30A depicts a front cross-sectional view of the jaw of FIG. 29,taken along line A-A;

FIG. 30B depicts a front cross-sectional view of the jaw of FIG. 29,taken along line B-B;

FIG. 31A depicts a front cross-sectional view of an alternate version ofa jaw similar to the jaw of FIG. 29, and taken along line A-A;

FIG. 31B depicts another front cross-sectional view of the alternateversion of the jaw of FIG. 31A, taken along line B-B of FIG. 29;

FIG. 32A depicts a front cross-sectional view of an alternate version ofa jaw similar to the jaw of FIG. 29, taken along line A-A;

FIG. 32B depicts another front cross-sectional view of the alternateversion of the jaw of FIG. 32A, taken along line B-B of FIG. 29;

FIG. 33A depicts a front cross-sectional view of an alternate version ofa jaw similar to the jaw of FIG. 29, taken along line A-A;

FIG. 33B depicts another front cross-sectional view of the alternateversion of the jaw of FIG. 33A, taken along line B-B of FIG. 29;

FIG. 34A depicts a front cross-sectional view of an alternate version ofa jaw similar to the jaw of FIG. 29, taken along line A-A;

FIG. 34B depicts another front cross-sectional view of the alternateversion of the jaw of FIG. 34A, taken along line B-B of FIG. 29;

FIG. 35 depicts an enlarged perspective view of a distal portion of ajaw of an alternative version of an end effector, showing a highcontrast placement tip;

FIG. 36 depicts an enlarged side view of a distal portion of analternate version of an end effector having a straight placement tip;

FIG. 37 depicts an enlarged side view of a distal portion of analternate version of an end effector having a straight placement tipwith a taper;

FIG. 38 depicts an enlarged top view of a distal portion of an anvil andplacement tip usable with the end effectors of FIGS. 36 and 37;

FIG. 39 depicts an enlarged top view of a distal portion of anotherexemplary anvil and placement tip usable with the end effectors of FIGS.36 and 37;

FIG. 40 depicts an enlarged perspective view of a distal portion of anexemplary alternative cartridge for an end effector for use with thesurgical stapling instruments described herein;

FIG. 41 depicts a side view of a distal portion of an exemplaryalternative end effector having the cartridge of FIG. 40, shown withouttissue capture;

FIG. 42 depicts a side view of a distal portion of the end effector ofFIG. 41, shown with tissue captured between the anvil and the cartridge;

FIG. 43 depicts an enlarged side view of a distal portion of anotherexemplary end effector for use with the surgical stapling instrumentsdescribed herein, showing a deformable tip extending from a thicker jaw;

FIG. 44 depicts an enlarged side view of a distal portion of anotherexemplary end effector for use with the surgical stapling instrumentsdescribed herein, showing a deformable tip extending from a thicker jawin a touching or contacting configuration with the opposite jaw;

FIG. 45 depicts an enlarged side view of a distal portion of anotherexemplary end effector for use with the surgical stapling instrumentsdescribed herein, showing a deformable tip extending from a thicker jawin a straight configuration; and

FIG. 46 depicts an enlarged side view of a distal portion of anotherexemplary end effector for use with the surgical stapling instrumentsdescribed herein, showing a deformable tip extending from a thicker jawin a curved non-touching or non-contacting configuration with theopposite jaw;

FIG. 47 depicts an exploded perspective view of an enlarged portion ofan exemplary end effector having a deflectable tip;

FIG. 48 depicts a side cross-sectional view of the end effector of FIG.47;

FIG. 49 depicts a top view of the end effector of FIG. 47, shown with aportion in phantom to reveal internal components;

FIG. 50 depicts an exploded perspective view of an enlarged portion ofan exemplary end effector having a deflectable tip;

FIG. 51 depicts a perspective view of the end effector of FIG. 50;

FIG. 52 depicts a perspective view of an enlarged portion of anexemplary end effector having a deflectable tip;

FIG. 53 depicts a perspective view of the end effector of FIG. 52, shownwith the deflectable tip in phantom to show other components of the endeffector

FIG. 54 depicts a perspective view of another exemplary surgicalstapling instrument with another exemplary end effector with anotherexemplary placement tip, where the upper and lower jaws are in an openconfiguration;

FIG. 55 depicts an enlarged schematic perspective view of the endeffector of

FIG. 54 with the placement tip and the lower jaw in a closedconfiguration;

FIG. 56 depicts a schematic side view of the end effector of FIG. 55 inthe closed configuration;

FIG. 57 depicts a schematic top view of the placement tip and anvil ofFIG. 55;

FIG. 58A depicts a transverse cross-sectional view of first and secondlegs of the placement tip of FIG. 57, taken along line 58A-58A of FIG.57;

FIG. 58B depicts a longitudinal cross-sectional view of a distal portionof the placement tip of FIG. 57, taken along line 58B-58B of FIG. 57;

FIG. 59 depicts a perspective view of an anvil and another exemplaryplacement tip with a malleable member;

FIG. 60 depicts an exploded perspective view of the anvil and theplacement tip of FIG. 59, but with the malleable member separated fromthe placement tip;

FIG. 61 depicts a top view of another exemplary end effector thatincludes a lower jaw as well as the anvil and the placement tip of FIG.59;

FIG. 62 depicts an enlarged top view of the placement tip of FIG. 61;

FIG. 63A depicts a side view of the placement tip of FIG. 61 in a firstbent configuration;

FIG. 63B depicts a side view of the placement tip of FIG. 61 in a secondbent configuration;

FIG. 64 depicts a perspective view of another exemplary placement tipwith a malleable member embedded within the placement tip;

FIG. 65 depicts a top view another exemplary end effector that includesa lower jaw as well as the anvil and the placement tip of FIG. 64;

FIG. 66A depicts a side view of the end effector of FIG. 65 in a firstbent configuration; and

FIG. 66B depicts a side view of the end effector of FIG. 65 in a secondbent configuration;

FIG. 67 depicts a perspective view of another exemplary surgicalstapling instrument with another exemplary end effector with anotherexemplary placement tip, where the upper and lower jaws are in an openconfiguration;

FIG. 68 depicts an enlarged perspective view of a distal portion of theend effector of FIG. 67, with the upper and lower jaws in a closedconfiguration;

FIG. 69 depicts a side view of the distal portion of the end effector ofFIG. 67 in the closed configuration;

FIG. 70 depicts a top view of the end distal portion of the effector ofFIG. 67;

FIG. 71 depicts a cross-sectional view of the anvil of the end effectorof FIG. 67, taken along line 71-71 of FIG. 70;

FIG. 72 depicts a cross-sectional view of the placement tip of the endeffector of FIG. 67, taken along line 72-72 of FIG. 70;

FIG. 73 depicts a cross-sectional view of the placement tip of the endeffector of FIG. 67, taken along line 73-73 of FIG. 70;

FIG. 74 depicts a cross-sectional view of the placement tip of the endeffector of FIG. 67, taken along line 74-74 of FIG. 70;

FIG. 75 depicts a cross-sectional view of the placement tip of the endeffector of FIG. 67, taken along line 75-75 of FIG. 70;

FIG. 76 depicts a cross-sectional view of the placement tip of the endeffector of FIG. 67, taken along line 76-76 of FIG. 70;

FIG. 77 depicts a cross-sectional view of the placement tip of the endeffector of FIG. 67, taken along line 77-77 of FIG. 70;

FIG. 78 depicts a perspective view of a distal portion of anotherexemplary end effector with another exemplary placement tip in a closedconfiguration;

FIG. 79 depicts a side view of the distal portion of the end effector ofFIG. 78;

FIG. 80 depicts a top view of the distal portion of the end effector ofFIG. 78 in the closed configuration; and

FIG. 81 depicts a perspective view of a distal portion of anotherexemplary end effector with another exemplary placement tip in a closedconfiguration.

FIG. 82 depicts a perspective view of another exemplary surgicalstapling instrument including another exemplary end effector and anotherexemplary placement tip, where the upper and lower jaws are in an openconfiguration;

FIG. 83A depicts an enlarged top view of the end effector of FIG. 82 ina first angled position;

FIG. 83B depicts an enlarged top view of the end effector of FIG. 82 ina second angled position;

FIG. 83C depicts an enlarged top view of the end effector of FIG. 82 ina third angled position;

FIG. 83D depicts an enlarged top view of the end effector of FIG. 82 ina fourth angled position;

FIG. 83E depicts an enlarged top view of the end effector of FIG. 82 ina fifth angled position;

FIG. 84A depicts an enlarged perspective view of the end effector ofFIG. 82 prior to entering a tissue opening;

FIG. 84B depicts a perspective view of the end effector of FIG. 82moving laterally to a second position entering the tissue opening ofFIG. 84A;

FIG. 84C depicts a perspective view of the end effector of FIG. 82moving laterally to a third position already through the tissue openingof FIG. 84A;

FIG. 84D depicts a perspective view of the end effector of FIG. 82 moveddistally to a fourth position after moving laterally through the tissueopening of FIG. 84A;

FIG. 85 depicts a perspective view of another exemplary surgicalstapling instrument with another exemplary end effector with anotherexemplary placement tip, where the upper and lower jaws are in an openconfiguration;

FIG. 86 depicts an enlarged perspective view of a distal portion of theend effector of FIG. 85, with the upper and lower jaws in a closedconfiguration;

FIG. 87 depicts a front view of the end effector of FIG. 86 in theclosed configuration;

FIG. 88 depicts a top view of the distal portion of the end effector ofFIG. 86;

FIG. 89 depicts a side view of the distal portion of the end effector ofFIG. 86 in the closed configuration;

FIG. 90A depicts a cross-sectional view of a proximal portion of theplacement tip of FIG. 89, taken along line 90A-90A of FIG. 89;

FIG. 90B depicts a cross-sectional view of a central portion of theplacement tip of FIG. 89, taken along line 90B-90B of FIG. 89;

FIG. 90C depicts a cross-sectional view of a distal portion of theplacement tip of FIG. 89, taken along line 90C-90C of FIG. 89;

FIG. 91 depicts a perspective view of a distal portion of anotherexemplary end effector that includes another exemplary placement tip ina closed configuration;

FIG. 92 depicts a front view of the end effector of FIG. 91 in theclosed configuration;

FIG. 93 depicts a top view of the distal portion of the end effector ofFIG. 91;

FIG. 94 depicts a side view of the distal portion of the end effector ofFIG. 91 in the closed configuration;

FIG. 95A depicts a cross-sectional view of a proximal portion of theplacement tip of FIG. 94, taken along line 95A-95A of FIG. 94;

FIG. 95B depicts a cross-sectional view of a central portion of theplacement tip of FIG. 94, taken along line 95B-95B of FIG. 94;

FIG. 95C depicts a cross-sectional view of a distal portion of theplacement tip of FIG. 94, taken along line 95C-95C of FIG. 94;

FIG. 96 depicts a top view of a distal portion of another exemplary endeffector that includes another exemplary placement tip;

FIG. 97 depicts a side view of the distal portion of the distal portionof the end effector of FIG. 96 in a closed configuration;

FIG. 98A depicts a cross-sectional view of a proximal portion of theplacement tip of FIG. 2397 taken along line 98A-98A of FIG. 97;

FIG. 98B depicts a cross-sectional view of a central portion of theplacement tip of FIG. 97, taken along line 98B-98B of FIG. 97;

FIG. 98C depicts a cross-sectional view of a distal portion of theplacement tip of FIG. 97, taken along line 98C-98C of FIG. 97;

FIG. 99 depicts a perspective view of another surgical staplinginstrument with another end effector with another placement tip, wherethe upper and lower jaws are in an open configuration;

FIG. 100 depicts a perspective view of an exemplary upper buttress andan exemplary lower buttress of an exemplary buttress assembly, each ofwhich may be applied to the end effector of FIG. 2 or the end effectorof FIG. 8;

FIG. 101A depicts a cross-sectional end view of a portion of the endeffector of FIG. 2 with a buttress assembly formed by the buttresses ofFIG. 100 applied to the end effector, with tissue positioned between thebuttresses in the end effector, and with the end effector in an openconfiguration;

FIG. 101B depicts a cross-sectional end view of the end effector andbuttress assembly of FIG. 101A, with tissue positioned between thebuttresses in the end effector, and with the end effector in a closedconfiguration;

FIG. 101C depicts a cross-sectional view of a staple and the buttressassembly of FIG. 101A having been secured to the tissue by the endeffector of FIG. 2;

FIG. 102 depicts a perspective view of staples and the buttress assemblyof FIG. 13A having been secured to the tissue by the end effector ofFIG. 2;

FIG. 103 depicts a perspective view of an exemplary buttress appliercartridge that may be used to carry and apply the buttress assembly ofFIG. 100;

FIG. 104 depicts a top plan view of the buttress applier cartridge ofFIG. 103;

FIG. 105A depicts a perspective view of the end effector of FIG. 2 andthe buttress applier cartridge of FIG. 103, with the end effectorapproaching the buttress applier cartridge;

FIG. 105B depicts a perspective view of the end effector of FIG. 2 andthe buttress applier cartridge of FIG. 103, with the buttress appliercartridge positioned in the end effector;

FIG. 106 depicts a schematic perspective view of another exemplarybuttress applier cartridge that may be used to carry and apply thebuttress assembly of FIG. 103;

FIG. 107 depicts a schematic front plan view of the buttress appliercartridge of FIG. 106;

FIG. 108A depicts a schematic cross-sectional side view of the endeffector of FIG. 99 and the buttress applier cartridge of FIG. 106, withthe buttress applier cartridge positioned in the end effector, and withthe end effector in an open configuration;

FIG. 108B depicts a schematic cross-sectional side view of the endeffector of FIG. 99 and the buttress applier cartridge of FIG. 106, withthe buttress applier cartridge positioned in the end effector, and withthe end effector in a closed configuration;

FIG. 109 depicts a schematic perspective view of another exemplarybuttress applier cartridge that may be used to carry and apply thebuttress assembly of FIG. 100;

FIG. 110 depicts a schematic front plan view of the buttress appliercartridge of FIG. 109;

FIG. 111A depicts a schematic cross-sectional side view of the endeffector of FIG. 99 and the buttress applier cartridge of FIG. 109, withthe buttress applier cartridge positioned in the end effector, and withthe end effector in an open configuration; and

FIG. 111B depicts a schematic cross-sectional side view of the endeffector of FIG. 99 and the buttress applier cartridge of FIG. 109, withthe buttress applier cartridge positioned in the end effector, and withthe end effector in a closed configuration.

The drawings are not intended to be limiting in any way, and it iscontemplated that various embodiments of the invention may be carriedout in a variety of other ways, including those not necessarily depictedin the drawings. The accompanying drawings incorporated in and forming apart of the specification illustrate several aspects of the presentinvention, and together with the description serve to explain theprinciples of the invention; it being understood, however, that thisinvention is not limited to the precise arrangements shown.

DETAILED DESCRIPTION

The following description of certain examples of the invention shouldnot be used to limit the scope of the present invention. Other examples,features, aspects, embodiments, and advantages of the invention willbecome apparent to those skilled in the art from the followingdescription, which is by way of illustration, one of the best modescontemplated for carrying out the invention. As will be realized, theinvention is capable of other different and obvious aspects, all withoutdeparting from the invention. Accordingly, the drawings and descriptionsshould be regarded as illustrative in nature and not restrictive.

It is further understood that any one or more of the teachings,expressions, embodiments, examples, etc. described herein may becombined with any one or more of the other teachings, expressions,embodiments, examples, etc. that are described herein. Thefollowing-described teachings, expressions, embodiments, examples, etc.should therefore not be viewed in isolation relative to each other.Various suitable ways in which the teachings herein may be combined willbe readily apparent to those of ordinary skill in the art in view of theteachings herein. Such modifications and variations are intended to beincluded within the scope of the claims.

For clarity of disclosure, the terms “proximal” and “distal” are definedherein relative to a human or robotic operator of the surgicalinstrument. The term “proximal” refers the position of an element closerto the human or robotic operator of the surgical instrument and furtheraway from the surgical end effector of the surgical instrument. The term“distal” refers to the position of an element closer to the surgical endeffector of the surgical instrument and further away from the human orrobotic operator of the surgical instrument. In addition, the terms“upper,” “lower,” “lateral,” “transverse,” “bottom,” “top,” are relativeterms to provide additional clarity to the figure descriptions providedbelow. The terms “upper,” “lower,” “lateral,” “transverse,” “bottom,”“top,” are thus not intended to unnecessarily limit the inventiondescribed herein.

In addition, the terms “first” and “second” are used herein todistinguish one or more portions of the surgical instrument. Forexample, a first assembly and a second assembly may be alternatively andrespectively described as a second assembly and a first assembly. Theterms “first” and “second” and other numerical designations are merelyexemplary of such terminology and are not intended to unnecessarilylimit the invention described herein.

I. Exemplary Surgical Stapler

FIGS. 1-7 depict an exemplary surgical stapling and severing instrument(10) that is sized for insertion, in a nonarticulated state as depictedin FIG. 1, through a trocar cannula to a surgical site in a patient forperforming a surgical procedure. By way of example only, such a trocarmay be inserted in a patient's abdomen, between two of the patient'sribs, or elsewhere. In some settings, instrument (10) is used without atrocar. For instance, instrument (10) may be inserted directly through athoracotomy or other type of incision. Instrument (10) of the presentexample includes a handle portion (20) connected to a shaft (22). Shaft(22) distally terminates in an articulation joint (11), which is furthercoupled with an end effector (12). It should be understood that termssuch as “proximal” and “distal” are used herein with reference to aclinician gripping handle portion (20) of instrument (10). Thus, endeffector (12) is distal with respect to the more proximal handle portion(20). It will be further appreciated that for convenience and clarity,spatial terms such as “vertical,” “horizontal,” “upper,” and “lower” areused herein with respect to the drawings. However, surgical instrumentsare used in many orientations and positions, and these terms are notintended to be limiting and absolute.

In some versions, shaft (22) is constructed in accordance with at leastsome of the teachings of U.S. Pat. No. 9,795,379, entitled “SurgicalInstrument with Multi-Diameter Shaft,” issued Oct. 24, 2017, thedisclosure of which is incorporated by reference herein. Other suitableconfigurations for shaft (22) will be apparent to those of ordinaryskill in the art in view of the teachings herein.

Once articulation joint (11) and end effector (12) are inserted throughthe cannula passageway of a trocar, articulation joint (11) may beremotely articulated, as depicted in phantom in FIG. 1, by anarticulation control (13), such that end effector (12) may be deflectedfrom the longitudinal axis (LA) of shaft (22) at a desired angle (α).End effector (12) may thereby reach behind an organ or approach tissuefrom a desired angle or for other reasons. In some versions,articulation joint (11) enables deflection of end effector (12) along asingle plane. In some other versions, articulation joint (11) enablesdeflection of end effector along more than one plane. Articulation joint(11) and articulation control (13) may be configured in accordance withthe teachings of any of the numerous references that are cited herein.Alternatively, articulation joint (11) and/or articulation control (13)may have any other suitable configuration. By way of example only,articulation control (13) may instead be configured as a knob thatrotates about an axis that is perpendicular to the longitudinal axis(LA) of shaft (22).

In some versions, articulation joint (11) and/or articulation control(13) are/is constructed and operable in accordance with at least some ofthe teachings of U.S. Pat. No. 9,186,142, entitled “Surgical InstrumentEnd Effector Articulation Drive with Pinion and Opposing Racks,” issuedon Nov. 17, 2015, the disclosure of which is incorporated by referenceherein. Articulation joint (11) may also be constructed and operable inaccordance with at least some of the teachings of U.S. Pat. No.9,795,379, entitled “Surgical Instrument with Multi-Diameter Shaft,”issued Oct. 24, 2017, the disclosure of which is incorporated byreference herein. Other suitable forms that articulation joint (11) andarticulation control (13) may take will be apparent to those of ordinaryskill in the art in view of the teachings herein.

End effector (12) of the present example includes a lower jaw (16) and apivotable anvil (18). In the present example, anvil (18) can also beconsidered an upper jaw. Furthermore, in some versions like the presentexample, the upper jaw or anvil (18) pivots with respect to a stationarylower jaw (16); however, in some other versions the upper jaw or anvil(18) is stationary while the lower jaw (16) pivots. In some versions,lower jaw (16) is constructed in accordance with at least some of theteachings of U.S. Pat. No. 9,808,248, entitled “Installation Featuresfor Surgical Instrument End Effector Cartridge,” issued Nov. 7, 2017,the disclosure of which is incorporated by reference herein. Anvil (18)may be constructed in accordance with at least some of the teachings ofU.S. Pat. No. 9,517,065, entitled “Integrated Tissue Positioning and JawAlignment Features for Surgical Stapler,” issued Dec. 13, 2016, thedisclosure of which is incorporated by reference herein; U.S. Pat. No.9,839,421, entitled “Jaw Closure Feature for End Effector of SurgicalInstrument,” issued Dec. 12, 2017, the disclosure of which isincorporated by reference herein; and/or at least some of the teachingsof U.S. Pub. No. 2014/0239037, entitled “Staple Forming Features forSurgical Stapling Instrument,” published on Aug. 28, 2014, thedisclosure of which is incorporated by reference herein. Other suitableforms that lower jaw (16) and anvil (18) may take will be apparent tothose of ordinary skill in the art in view of the teachings herein.

Handle portion (20) includes a pistol grip (24) and a closure trigger(26). Closure trigger (26) is pivotable toward pistol grip (24) to causeclamping, or closing, of the anvil (18) toward lower jaw (16) of endeffector (12). Such closing of anvil (18) is provided through a closuretube (32) and a closure ring (33), which both longitudinally translaterelative to handle portion (20) in response to pivoting of closuretrigger (26) relative to pistol grip (24). Closure tube (32) extendsalong the length of shaft (22); and closure ring (33) is positioneddistal to articulation joint (11). Articulation joint (11) is operableto communicate/transmit longitudinal movement from closure tube (32) toclosure ring (33).

Handle portion (20) also includes a firing trigger (28). An elongatemember (not shown) longitudinally extends through shaft (22) andcommunicates a longitudinal firing motion from handle portion (20) to afiring beam (14) in response to actuation of firing trigger (28). Thisdistal translation of firing beam (14) causes the stapling and severingof clamped tissue in end effector (12), as will be described in greaterdetail below. Thereafter, triggers (26, 28) may be released to releasethe tissue from end effector (12).

FIGS. 3-6 depict end effector (12) employing an E-beam form of firingbeam (14) to perform a number of functions. It should be understood thatan E-beam form is just a merely illustrative example. Firing beam (14)may take any other suitable form, including but not limited tonon-E-beam forms. As best seen in FIGS. 4A-4B, firing beam (14) includesa transversely oriented upper pin (38), a firing beam cap (44), atransversely oriented middle pin (46), and a distally presented cuttingedge (48). Upper pin (38) is positioned and translatable within alongitudinal anvil slot (42) of anvil (18). Firing beam cap (44)slidably engages a lower surface of lower jaw (16) by having firing beam(14) extend through lower jaw slot (45) (shown in FIG. 4B) that isformed through lower jaw (16). Middle pin (46) slidingly engages a topsurface of lower jaw (16), cooperating with firing beam cap (44).Thereby, firing beam (14) affirmatively spaces end effector (12) duringfiring.

Some non-E-beam forms of firing beam (14) may lack upper pin (38),middle pin (46) and/or firing beam cap (44). Some such versions ofinstrument (10) may simply rely on closure ring (33) or some otherfeature to pivot anvil (18) to a closed position and hold anvil (18) inthe closed position while firing beam (14) advances to the distalposition. By way of example only, firing beam (14) and/or associatedlockout features may be constructed and operable in accordance with atleast some of the teachings of U.S. Pat. No. 9,717,497, entitled“Lockout Feature for Movable Cutting Member of Surgical Instrument,”issued Aug. 1, 2017, the disclosure of which is incorporated byreference herein. Other suitable forms that firing beam (14) may takewill be apparent to those of ordinary skill in the art in view of theteachings herein.

FIG. 3 shows firing beam (14) of the present example proximallypositioned and anvil (18) pivoted to an open position, allowing anunspent staple cartridge (37) to be removably installed into a channelof lower jaw (16). As best seen in FIGS. 5-6, staple cartridge (37) ofthis example includes a cartridge body (70), which presents an upperdeck (72) and is coupled with a lower cartridge tray (74). As best seenin FIG. 3, a vertical slot (49) is formed through part of staplecartridge (37). As also best seen in FIG. 3, three rows of stapleapertures (51) are formed through upper deck (72) on one side ofvertical slot (49), with another set of three rows of staple apertures(51) being formed through upper deck (72) on the other side of verticalslot (49). Of course, any other suitable number of staple rows (e.g.,two rows, four rows, any other number) may be provided. Referring backto FIGS. 4A-6, a wedge sled (41) and a plurality of staple drivers (43)are captured between cartridge body (70) and tray (74), with wedge sled(41) being located proximal to staple drivers (43). Wedge sled (41) ismovable longitudinally within staple cartridge (37); while stapledrivers (43) are movable vertically within staple cartridge (37).Staples (47) are also positioned within cartridge body (70), abovecorresponding staple drivers (43). In particular, each staple (47) isdriven vertically within cartridge body (70) by a staple driver (43) todrive staple (47) out through an associated staple aperture (51). Asbest seen in FIGS. 4A-4B and 6, wedge sled (41) presents inclined camsurfaces that urge staple drivers (43) upwardly as wedge sled (41) isdriven distally through staple cartridge (37).

In some versions, staple cartridge (37) is constructed and operable inaccordance with at least some of the teachings of U.S. Pat. No.9,517,065, entitled “Integrated Tissue Positioning and Jaw AlignmentFeatures for Surgical Stapler,” issued Dec. 13, 2016, the disclosure ofwhich is incorporated by reference herein. In addition or in thealternative, staple cartridge (37) may be constructed and operable inaccordance with at least some of the teachings of U.S. Pat. No.9,808,248, entitled “Installation Features for Surgical Instrument EndEffector Cartridge,” issued Nov. 7, 2017, the disclosure of which isincorporated by reference herein. Other suitable forms that staplecartridge (37) may take will be apparent to those of ordinary skill inthe art in view of the teachings herein.

With end effector (12) closed as depicted in FIGS. 4A-4B by distallyadvancing closure tube (32) and closure ring (33), firing beam (14) isthen advanced in engagement with anvil (18) by having upper pin (38)enter longitudinal anvil slot (42). A pusher block (80) (shown in FIG.5) is located at the distal end of firing beam (14) and is configured toengage wedge sled (41) such that wedge sled (41) is pushed distally bypusher block (80) as firing beam (14) is advanced distally throughstaple cartridge (37) when firing trigger (28) is actuated. During suchfiring, cutting edge (48) of firing beam (14) enters vertical slot (49)of staple cartridge (37), severing tissue clamped between staplecartridge (37) and anvil (18). As shown in FIGS. 4A-4B, middle pin (46)and pusher block (80) together actuate staple cartridge (37) by enteringinto vertical slot (49) within staple cartridge (37), driving wedge sled(41) into upward camming contact with staple drivers (43) that in turndrive staples (47) out through staple apertures (51) and into formingcontact with staple forming pockets (53) (shown in FIG. 3) on the innersurface of anvil (18). FIG. 4B depicts firing beam (14) fully distallytranslated after completing severing and stapling of tissue. It shouldbe understood that staple forming pockets (53) are intentionally omittedfrom the view in FIGS. 4A-4B; but staple forming pockets (53) are shownin FIG. 3. It should also be understood that anvil (18) is intentionallyomitted from the view in FIG. 5.

FIG. 7 shows end effector (12) having been actuated through a singlestroke through tissue (90). As shown, cutting edge (48) (obscured inFIG. 7) has cut through tissue (90), while staple drivers (43) havedriven three alternating rows of staples (47) through the tissue (90) oneach side of the cut line produced by cutting edge (48). Staples (47)are all oriented substantially parallel to the cut line in this example,though it should be understood that staples (47) may be positioned atany suitable orientations. In the present example, end effector (12) iswithdrawn from the trocar after the first stroke is complete, spentstaple cartridge (37) is replaced with a new staple cartridge, and endeffector (12) is then again inserted through the trocar to reach thestapling site for further cutting and stapling. This process may berepeated until the desired number of cuts and staples (47) have beenprovided. Anvil (18) may need to be closed to facilitate insertion andwithdrawal through the trocar; and anvil (18) may need to be opened tofacilitate replacement of staple cartridge (37).

It should be understood that cutting edge (48) may sever tissuesubstantially contemporaneously with staples (47) being driven throughtissue during each actuation stroke. In the present example, cuttingedge (48) just slightly lags behind driving of staples (47), such that astaple (47) is driven through the tissue just before cutting edge (48)passes through the same region of tissue, though it should be understoodthat this order may be reversed or that cutting edge (48) may bedirectly synchronized with adjacent staples. While FIG. 7 shows endeffector (12) being actuated in two layers (92, 94) of tissue (90), itshould be understood that end effector (12) may be actuated through asingle layer of tissue (90) or more than two layers (92, 94) of tissue.It should also be understood that the formation and positioning ofstaples (47) adjacent to the cut line produced by cutting edge (48) maysubstantially seal the tissue at the cut line, thereby reducing orpreventing bleeding and/or leaking of other bodily fluids at the cutline. Furthermore, while FIG. 7 shows end effector (12) being actuatedin two substantially flat, apposed planar layers (92, 94) of tissue, itshould be understood that end effector (12) may also be actuated acrossa tubular structure such as a blood vessel, a section of thegastrointestinal tract, etc. FIG. 7 should therefore not be viewed asdemonstrating any limitation on the contemplated uses for end effector(12). Various suitable settings and procedures in which instrument (10)may be used will be apparent to those of ordinary skill in the art inview of the teachings herein.

In one version, instrument (10) provides motorized control of firingbeam (14). Exemplary components that may be used to provide motorizedcontrol of firing beam (14) are shown and described in US. Pat. No.9,622,746, entitled “Distal Tip Features for End Effector of SurgicalInstrument,” issued Apr. 18, 2017, the disclosure of which isincorporated by reference herein. In addition to or in lieu of theforegoing, at least part of the motorized control may be configured inaccordance with at least some of the teachings of U.S. Pat. No.8,210,411, entitled “Motor-Driven Surgical Instrument,” issued Jul. 3,2012, the disclosure of which is incorporated by reference herein. Inaddition to or in lieu of the foregoing, the features operable to drivefiring beam (14) may be configured in accordance with at least some ofthe teachings of U.S. Pat. No. 8,453,914, the disclosure of which isincorporated by reference herein; and/or in accordance with at leastsome of the teachings of U.S. Pat. No. 8,453,914, the disclosure ofwhich is also incorporated by reference herein. Other suitablecomponents, features, and configurations for providing motorization offiring beam (14) will be apparent to those of ordinary skill in the artin view of the teachings herein. It should also be understood that someother versions may provide manual driving of firing beam (14), such thata motor may be omitted. By way of example only, firing beam (14) may beactuated in accordance with at least some of the teachings of any otherpatent/publication reference cited herein.

Instrument (10) may also include a lockout switch and lockout indicatoras shown and described in U.S. Pat. No. 9,622,746, entitled “Distal TipFeatures for End Effector of Surgical Instrument,” issued Apr. 18, 2017,the disclosure of which is incorporated by reference herein.Additionally, a lockout switch and/or lockout indication and associatedcomponents/functionality may be configured in accordance with at leastsome of the teachings of U.S. Pat. No. 7,644,848, entitled “ElectronicLockouts and Surgical Instrument Including Same,” issued Jan. 12, 2010,the disclosure of which is incorporated by reference herein.

Instrument (10) also include a manual return switch (116) configured toact as a “bailout” feature, enabling the operator to quickly beginretracting firing beam (14) proximally during a firing stroke. In otherwords, manual return switch (116) may be manually actuated when firingbeam (14) has only been partially advanced distally. Manual returnswitch (116) may provide further functionality in accordance with atleast some of the teachings of U.S. Pat. No. 9,622,746, entitled “DistalTip Features for End Effector of Surgical Instrument,” issued Apr. 18,2017, the disclosure of which is incorporated by reference herein.

In describing the operation of instrument (10), use of the term “pivot”(and similar terms with “pivot” as a base) should not be read asnecessarily requiring pivotal movement about a fixed axis. In someversions, anvil (18) pivots about an axis that is defined by a pin (orsimilar feature) that slides along an elongate slot or channel as anvil(18) moves toward lower jaw (16). In such versions, the pivot axistranslates along the path defined by the slot or channel while anvil(18) simultaneously pivots about that axis. In addition or in thealternative, the pivot axis may slide along the slot/channel first, withanvil (18) then pivoting about the pivot axis after the pivot axis hasslid a certain distance along the slot/channel. It should be understoodthat such sliding/translating pivotal movement is encompassed withinterms such as “pivot,” “pivots,” “pivotal,” “pivotable,” “pivoting,” andthe like. Of course, some versions may provide pivotal movement of anvil(18) about an axis that remains fixed and does not translate within aslot or channel, etc.

It should be understood that instrument (10) may be configured andoperable in accordance with any of the teachings of U.S. Pat. No.4,805,823; U.S. Pat. No. 5,415,334; U.S. Pat. No. 5,465,895; U.S. Pat.No. 5,597,107; U.S. Pat. No. 5,632,432; U.S. Pat. No. 5,673,840; U.S.Pat. No. 5,704,534; U.S. Pat. No. 5,814,055; U.S. Pat. No. 6,978,921;U.S. Pat. No. 7,000,818; U.S. Pat. No. 7,143,923; U.S. Pat. No.7,303,108; U.S. Pat. No. 7,367,485; U.S. Pat. No. 7,380,695; U.S. Pat.No. 7,380,696; U.S. Pat. No. 7,404,508; U.S. Pat. No. 7,434,715; U.S.Pat. No. 7,721,930; U.S. Pat. No. 8,408,439; and/or U.S. Pat. No.8,453,914. As noted above, the disclosures of each of those patents andpublications are incorporated by reference herein. Additional exemplarymodifications that may be provided for instrument (10) will be describedin greater detail below. Various suitable ways in which the belowteachings may be incorporated into instrument (10) will be apparent tothose of ordinary skill in the art. Similarly, various suitable ways inwhich the below teachings may be combined with various teachings of thepatents/publications cited herein will be apparent to those of ordinaryskill in the art. It should also be understood that the below teachingsare not limited to instrument (10) or devices taught in the patentscited herein. The below teachings may be readily applied to variousother kinds of instruments, including instruments that would not beclassified as surgical staplers. Various other suitable devices andsettings in which the below teachings may be applied will be apparent tothose of ordinary skill in the art in view of the teachings herein.

II. Exemplary End Effector with Visualization, Lead-In, and GatheringFeature

In some instances, it may be desirable to provide the user with bettervisualization of end effector (12). In particular, as end effector (12)is inserted into a surgical site, the user may rotate shaft (22) ofinstrument (10) during the procedure. As a result, end effector (12)also rotates. As end effector (12) rotates, it may be desirable for theuser to have visual access to the surgical site. For instance, the usermay wish to see the interface or contact between tissue (90) and endeffector (12). Since end effector (12) may be rotated about thelongitudinal axis (LA) relative to handle portion (20), the user mayview the surgical site such that lower jaw (16) of end effector isvisible rather than anvil (18). Alternatively, end effector (12) couldbe rotated such that when the user views end effector (12), anvil (18)is visible by the user. It may be desirable to provide visibility of thesurgical site for the user beyond what is possible in instrument (10) ofFIG. 1. For instance, in the case of some surgical procedures wherefluid carrying vessels are transected and stapled, it may be desirableto have visual confirmation that anvil (18) and lower jaw (16)completely cover the vessel to be cut, such that the vessel may be fullycut and stapled in one single actuation. In other words, the user maywish to avoid cutting and stapling only a portion of a vessel. Thus,some means of visual monitoring and/or feedback may be desirable so thatthe user will know that end effector (12) has been positioned properlywithin the surgical site for anvil (18) and lower jaw (16) to fullyclamp the vessel. One potential way of monitoring the surgical site mayinclude improving visualization of the area adjacent to the distal tipof lower jaw (16) and anvil (18). Furthermore, not only visualization ofthe distal end of end effector (12) may be desirable, but also it may bedesirable to construct end effector (12) such that the distal end ofanvil (18) is configured to urge tissue (e.g., a large vessel)proximally into the space between anvil (18) and lower jaw (16) as anvil(18) closes toward lower jaw (16).

FIG. 8 depicts an exemplary end effector (212) comprising an anvil (218)and a lower jaw (216). It will be appreciated that end effector (212)may be used in place of end effector (12) of instrument (10). Endeffector (212) may be integrally formed with instrument (10) or in thealternative may be interchangeable with end effector (12) of instrument(10).

Anvil (218) is operable to pivot relative to lower jaw (216). Anvil(218) and lower jaw (216) may clamp tissue (90) similarly to clampingperformed by anvil (18) and lower jaw (16) shown in FIG. 1. End effector(212) further comprises a cartridge (237) operable to be placed in lowerjaw (216) similarly to cartridge (37) shown in FIG. 3.

Anvil (218) as can be seen in FIGS. 8-10 has an elongated shape wherethe distal portion of anvil (218) angles toward cartridge (237). Thedistal portion of anvil (218) angles toward cartridge (237) such thatthe distal most tip (219) of anvil (218) extends distally longitudinallyfurther than cartridge (237). Though in some versions, distal tip (219)may extend to a distance longitudinally equal to cartridge (237) orproximal relative to the distal most point on cartridge (237).Furthermore, anvil (218) angles toward cartridge (237) through a gentleslope. As seen best in FIG. 10, anvil (218) includes sides (241) thattaper as they approach the distal most tip (219) of anvil (218). By wayof example, anvil (218) is shaped in FIG. 8 similarly to an inverted skitip. The angled shape of anvil (218) may provide easier insertion of endeffector (212) into a surgical site. For instance, the gentle slope orinverted ski tip shape of anvil (218) may provide an atraumatic tissuedeflection surface as anvil (218) contacts or moves through tissue. Suchatraumatic tissue deflection may include urging tissue (e.g., a largevessel) proximally into the space between anvil (218) and lower jaw(216) as anvil (218) closes toward lower jaw (216). Once placed into asurgical site, the angled shape of anvil (218) may also provide bettermaneuverability of end effector (212) and better visibility of thedistal end of end effector (212) in relation to anatomical structures atthe surgical site. Other suitable variations of anvil (218) will beapparent to one of ordinary skill in the art in view of the teachingsherein.

Cartridge (237) is operable to hold staples similar to staples (47)shown in FIG. 4A for driving into tissue. As shown in FIG. 9, the distalend of cartridge (237) has a triangular profile. In particular, thedistal end of cartridge (237) comprises an upper tapered surface (239)and a lower tapered surface (238). Additionally, the distal end ofcartridge (237) comprises a tapered side surface (243) on each side. Inthe present example, each tapered side surface (243) of cartridge (237)generally aligns with the taper presented by sides (241) of anvil (218).Thus, as shown in FIG. 10, side surfaces (243) of cartridge (237) do notextend outwardly from longitudinal axis (LA) of end effector (212) pastsides (241) of anvil (218). Upper tapered surface (239) and lowertapered surface (238) lead to the distal most end of cartridge (237).Lower tapered surface (238) defines a sight line (240) such that onceend effector (212) is inserted into a surgical site, the user can seealong sight line (240). Sight line (240) extends along the edge of lowertapered surface (238). It will be appreciated that the planar shape oflower tapered surface (238) may be operable to allow the user tovisualize and/or nearly visualize the distal tip (219) of anvil (218).In particular, sight line (240) intersects longitudinal axis (LA), whichextends longitudinally through end effector (212), to form a viewingangle (θ).

Viewing angle (θ) may establish the relative visibility that a user hasregarding distal tip (219). In particular, the user can see in front ofdistal tip (219) along any line of sight that passes through theintersection of sight line (240) and longitudinal axis (LA) withinviewing angle (θ). For instance, as viewing angle (θ) increases, theuser would have greater visibility of the area immediately in front ofdistal tip (219) from proximal vantage points; whereas as viewing angle(θ) decreases, the user has less visibility of the area in front ofdistal tip (219) from proximal vantage points. In some versions, viewingangle (θ) defines an angle greater than 90 degrees. Additionally, insome versions, viewing angle (θ) defines an angle greater than 135degrees. Other suitable angles for viewing angle (θ) will be apparent toone of ordinary skill in the art in view of the teachings herein. In theillustrated version, the user generally looks along sight line (240) oralong some other line of sight within viewing angle (θ), thus, the userhas visibility along sight line as well as any area within viewing angle(θ). The underside of distal tip (219) is further slightly rounded toaid in the visibility of the intersection of longitudinal axis (LA) andsight line (240).

When tissue (90) is clamped between a closed cartridge (237) and anvil(218), the user can look along sight line (240) or elsewhere withinviewing angle (θ) to see, for instance, precisely where anvil (218) hasclamped tissue (90). Furthermore, the user would be able to determinewhether the tissue is completely clamped between anvil (218) andcartridge (237) such that tissue does not spill over the end of endeffector (212). The user may be able to also visualize the quality ofthe clamp between anvil (218) and cartridge (237) against tissue (90).It will be appreciated that in some instances, end effector (212) may berotated before, during, or after clamping tissue (90). As a result, thetapered shape of anvil (218) may also provide more accessible viewing ofdistal tip (219) or substantially adjacent distal tip (219). The taperof anvil (218) along with lower tapered surface (238) of cartridge (237)may further promote easy insertion of end effector (212) into tissue inan atraumatic manner. Furthermore, it may be easier to fit end effector(212) through a trocar or other devices operable to introduce endeffector (212) into a surgical site due to the tapered end of endeffector (212). For instance, once distal tip (219) is fit into atrocar, lower tapered surface (238) and the tapered shape of anvil (218)may provide a lead-in, guiding the rest of end effector (212) into thetrocar. In view of the teachings herein, those of ordinary skill in theart will further appreciate that visibility and maneuverability can beenhanced by the tapered design for both sides (241) of anvil (218) andeach side (243) of cartridge (237).

In addition to the foregoing, end effector (212) and versions ofinstrument (10) incorporating end effector (212) may be configured andoperable in accordance with at least some of the teachings of U.S. Pat.No. 9,186,142, entitled “Surgical Instrument End Effector ArticulationDrive with Pinion and Opposing Racks,” issued Nov. 17, 2015, thedisclosure of which is incorporated by reference herein; U.S. Pat. No.9,717,497, entitled “Lockout Feature for Movable Cutting Member ofSurgical Instrument,” issued Aug. 1, 2017, the disclosure of which isincorporated by reference herein; U.S. Pat. No. 9,517,065, entitled“Integrated Tissue Positioning and Jaw Alignment Features for SurgicalStapler,” issued Dec. 13, 2016, the disclosure of which is incorporatedby reference herein; U.S. Pat. No. 9,839,421, entitled “Jaw ClosureFeature for End Effector of Surgical Instrument,” issued Dec. 12, 2017,the disclosure of which is incorporated by reference herein; U.S. Pat.No. 9,622,746, entitled “Distal Tip Features for End Effector ofSurgical Instrument,” issued Apr. 18, 2017, the disclosure of which isincorporated by reference herein; U.S. Pub. No. 2014/0239037, entitled“Staple Forming Features for Surgical Stapling Instrument,” publishedAug. 28, 2014, the disclosure of which is incorporated by referenceherein; U.S. Pat. No. 9,795,379, entitled “Surgical Instrument withMulti-Diameter Shaft,” issued Oct. 24, 2017, the disclosure of which isincorporated by reference herein; and/or U.S. Pat. No. 9,808,248,entitled “Installation Features for Surgical Instrument End EffectorCartridge,” issued Nov. 7, 2017, the disclosure of which is incorporatedby reference herein. Further modifications that may be incorporated intoend effector (212) will be described in greater detail below.

III. Exemplary End Effectors with Bent or Angled Elastically DeformableAnvil Tips

In some procedures, it may be necessary to cut along tissue or throughtissue where more than one cutting sequence is necessary to complete theprocedure—in other words making sequential cuts along a continuous path.In such procedures, this sequential cutting technique can be defined as“marching.” With procedures that involve marching, instrument (10) maybe placed at the surgical site, actuated to cut and staple, then removedfrom the surgical site for installing a new cartridge (37), and then beplaced back at the surgical site again for the next cut and staple alongthe same path in which the previous cutting and stapling cycle occurred.This process is repeated until the cut and staple procedure is complete.As can be seen in FIGS. 4A-4B and FIG. 7, the distal end configurationof end effector (12) provides a gap between the distal end of anvil (18)and the distal end of cartridge (37). This gap may facilitate marchingby providing an atraumatic space for tissue to enter the distal end ofend effector (12) at the beginning of each marching step.

As noted above, the distal end configuration of end effector (212) isdifferent from the distal end configuration of end effector (12); withthe different configuration of end effector (212) providing differentpotential advantages. In particular, the distal end configuration of endeffector (212) may provide improved maneuverability and improvedvisibility of the relationship between the distal end of end effector(212) and adjacent anatomical structures. In addition, the distal endconfiguration of end effector (212) may provide tissue-gathering effectsby urging tissue proximally into the space between anvil (218) and lowerjaw (216) as anvil (218) is closed toward lower jaw (216). However, inversions where all the structures of end effector (212) are rigid, thebent configuration of distal tip (219) of anvil (218) may not lenditself well to marching operations, as distal tip (219) may imparttrauma to tissue that is not gathered into the space between anvil (218)and lower jaw (216) as anvil (218) is closed toward lower jaw (216).Thus, in versions where all the structures of end effector (212) arerigid, end effector (212) may be best suited for cutting and staplingoperations (e.g., vessel transection) where all of the tissue that is tobe cut and stapled is gathered proximal to distal tip (219).

In view of the foregoing, it may be desirable to provide a variation ofend effectors (12, 212) that provides the marching capabilities of endeffector (12), the improved visibility associated with end effector(212), and the tissue gathering capabilities of end effector (212),without providing an increased risk of trauma that might otherwise beassociated with fully rigid versions of end effector (212). Thefollowing describes several merely illustrative examples of suchvariations of end effectors (12, 212). In the following examples, ananvil has a distal tip that is resiliently biased to assume a bent orangled configuration like distal tip (219); yet the resiliently biaseddistal tip is deflectable away from the lower jaw in response to asufficient load on the distal tip. It will be understood in view of theteachings herein that providing an anvil with an elastically deformableangled distal tip portion can provide an additional level ofmaneuverability benefits in terms of navigating through tissue to asurgical site. In this manner, the deformable distal tip portion maydeflect or deform to promote smooth and atraumatic movement of the endeffector through tissue, particularly during marching operations.Additionally, with an anvil having a bias to an angled position when notin a loaded state or contacted by surrounding tissue, enhancedvisualization during tissue capture and cutting can be achieved comparedto using end effectors with a straight or non-angled anvil. Moreover, ananvil with a distal tip that is biased to an angled position may providesome degree of tissue gathering effects up until reaching a load pointthat would be associated with marching rather than being associated withsimply gathering a relatively small tissue structure between the anviland lower jaw.

FIG. 11 shows another exemplary instrument (310) configured as asurgical stapler. Instrument (310) comprises a handle portion (320) anda shaft (322). Instrument (310) has a modular configuration such thatshaft (322) is selectively removable from, and attachable to, handleportion (320). Instrument (310) is configured similarly to instrument(10) such that the operability and use of instrument (310) is the sameas described above for instrument (10) with the added feature ofinstrument (310) being a modular configuration. With its modularconfiguration, instrument (310) provides a way to change the endeffector. Such a change in the end effector may be made to replace anotherwise worn end effector, or to provide for a different end effectorconfiguration based on the procedure or user preference. In addition toor in lieu of the foregoing, features operable for providing the modularconfiguration of instrument (310) may be configured in accordance withat least some of the teachings of U.S. Pub. No. 2017/086823, entitled“Surgical Stapling Instrument with Shaft Release, Powered Firing, andPowered Articulation,” published Mar. 30, 2017, the disclosure of whichis incorporated by reference herein. Other suitable components,features, and configurations for providing instrument (310) with amodular configuration will be apparent to those of ordinary skill in theart in view of the teachings herein. Moreover, it will be understood bythose of ordinary skill in the art in view of the teachings herein, thatinstrument (10) may be modified to incorporate a modular configurationas shown and described with respect to instrument (310) or otherinstruments incorporated by reference herein.

In the illustrated example of FIG. 11, instrument (310) comprises an endeffector (312) having an anvil (318) that has an angled distal tip(319). Furthermore, distal tip (319) of anvil (318) is elasticallydeformable. In this manner, and as shown best in FIGS. 12A and 12B,angled distal tip (319) is operable to elastically deform from a firstangled position to a second position. The second position for angleddistal tip (319) may be substantially straight in some versions, but maybe angled to a degree (e.g., slightly above or slightly below thelongitudinal axis (A1)) in other versions. It should be understood thatthe second position for angled distal tip (319) may be defined by thecharacteristics (e.g., thickness, density, etc.) of the tissue that isbeing captured between anvil (318) and lower jaw (16). In the presentexample, end effector (312) is provided on shaft (322) that isdetachable from handle portion (320). By way of example only, shaft(322) may be detachable from handle portion (320) in accordance with atleast some of the teachings of U.S. Pat. No. 9,913,642, entitled“Surgical Instrument Comprising a Sensor System,” issued Mar. 13, 2018,the disclosure of which is incorporated by reference herein. In someother versions, shaft (322) is not detachable from handle portion (320).

It will be appreciated that end effector (312) may be used in place ofend effector (12) shown in FIG. 1. In some versions, end effector (312)may be integrally formed with shaft (22) or alternatively may beseparately formed and then combined. In some versions, end effector(312) may be provided for use in robotic systems. In such roboticsystems, modular shaft (322) having end effector (312) may be attachableto a portion of the robotic system for use such that handle portion(320) is replaced by components of the robotic system. Still in otherexamples, end effector (312) may be adapted for use with a roboticsystem in a manner where end effector (312) connects with the roboticsystem without necessarily connecting the entire modular shaft (322). Inview of the teachings herein, other ways to incorporate an end effectorhaving an angled elastically deformable anvil tip into a user operatedor robotic operated instrument will be apparent to those of ordinaryskill in the art.

FIG. 12A shows an enlarged side view of the distal end of end effector(312). End effector (312) comprises anvil (318) and lower jaw (16) thataccepts cartridge (37) as described above with respect to instrument(10). Anvil (318) pivotably rotates toward lower jaw (16) in the samemanner as anvil (18) as described above with respect to instrument (10).In this configuration, end effector (312) is similar to end effector(12), however, anvil (318) comprises angled distal tip (319) that iselastically deformable. As shown in FIG. 12A, tip (319) is imparted witha bias to an angled position that is shown in FIG. 11 and in phantom inFIG. 12A. Tip (319) assumes this angled position when end effector (312)is not clamping tissue and is open, as shown in FIG. 11; or closedwithout clamping tissue, as shown in phantom in FIG. 12A. In instanceswhen end effector (312) is in this angled state or position, endeffector (312) can be considered not loaded or in a non-loaded state orposition. Conversely when end effector (312) is clamping tissue, endeffector (312) can be considered loaded or in a loaded state orposition.

When closed and not clamping tissue between anvil (318) and lower jaw(16), tip (319) contacts cartridge (37). In this position, an undersidesurface (324) of tip (319) defines a plane that intersects alongitudinal axis (A1) defined by shaft (322) to form an angle (θ1).When closed and clamping tissue (90) between anvil (318) and lower jaw(16), underside surface (324) of tip (319) contacts tissue (90). In thisposition, underside surface (324) of tip (319) defines a plane thatintersects longitudinal axis (A1) to form an angle (θ2). In theillustrated example of FIG. 12A, angles (θ1, θ2) are relative tolongitudinal axis (A1), and the sum of angles (θ1, θ2) represent therange of motion distal tip (319) undergoes. By way of example only, andnot limitation, in some examples angle (θ1) is between about 20 andabout 70 degrees, or more particularly between about 30 degrees andabout 50 degrees, in a downward direction from longitudinal axis (A1)toward cartridge (37). By way of example only, and not limitation, insome examples angle (θ2) is between about 0 and about 90 degrees in anupward direction from longitudinal axis (A1) away from cartridge (37).By way of example only, and not limitation, in some examples the rangeof motion undergone by tip (319) is between about 20 degrees and about110 degrees. The angles described for angles (θ1, θ2) are exemplary onlyand not limiting. Other suitable angles will be apparent to those ofordinary skill in the art in view of the teachings herein.

Additionally, in some instances longitudinal axis (A1) represents azero-degree reference and angles relative thereto may be positive ornegative. For instance, where an angle is in a downward direction fromlongitudinal axis (A1) toward cartridge (37), the angle may becharacterized as a negative angle. Similarly, where an angle is in anupward direction from longitudinal axis (A1) away from cartridge (37),the angle may be characterized as a positive angle. When using theseconventions, the range of motion of distal tip (319) due to deformationcan be understood as the sum of the absolute value of the angle whendistal tip (319) is in the position contacting cartridge (37), and theangle when distal tip (319) is in the deformed state when clampingtissue.

FIG. 12B shows another side view of an alternate end effector (412)similar to end effector (312) of FIG. 12A. With end effector (312), whenanvil (318) is in its angled and non-deformed state (as seen in phantomin the view of FIG. 12A), anvil (318) extends to a point even with orproximal to the distal most end of cartridge (37). When anvil (318) isdeformed such that it is deflected upwardly, the end of distal tip (319)extends to a point just distal to the distal most end of cartridge (37).With end effector (412), as shown in FIG. 12B, when anvil (318) is inits angled and non-deformed state (as seen in phantom in the view ofFIG. 12B), anvil (318) extends to a point even with or proximal to thedistal most end of cartridge (37). When anvil (318) is deformed suchthat it is deflected upwardly, the end of a distal tip (319) of anvil(318) extends to a point even with or proximal to the distal most end ofcartridge (37). In this manner, anvil (318) of end effector (412)remains even with or proximal to the distal most end of cartridge (37)when anvil (318) is in its angled state or deformed state such thatanvil (318) does not extend past the distal most end of cartridge (37)whether anvil (318) is in its angled and non-deformed state or in itsdeformed state. In some instances, this can be achieved by modifyinganvil (318) such that distal tip (319) of anvil is shortened in length.In other instances, instruments (10, 310) may be modified to provide fora slight proximal retraction of anvil (318) when clamping. In view ofthe teachings herein, other ways to modify end effector (412) as itrelates to control of anvil (318) position, will be apparent to those ofordinary skill in the art.

A. Overmolded Anvil Tip

FIGS. 13-15 show enlarged distal views of end effector (312) toillustrate an exemplary construction. The constructions shown in FIGS.13-15 also applies to end effector (412) shown in FIG. 12B, except forthe anvil (318) length difference noted above. As shown in the top viewof FIG. 13, end effector (312) comprises anvil (318) where distal tip(319) comprises a rigid portion (326) and a deflectable portion (328).In the present example, deflectable portion (328) is overmolded ontorigid portion (326) to form distal tip (319) of anvil (318). In theillustrated example as shown in FIG. 13, the outline of cartridge (37)is shown in phantom to reveal underside surface (324) of anvil (318).Rigid portion (326) of distal tip (319) extends from a body (330) ofanvil (318). In the present example, body (330) is comprised of metaland rigid portion (326) is an extension of metal body (330) into distaltip (319). In other versions, body (330) and/or rigid portion (326) canbe comprised of materials other than metal, including but not limited toplastic, ceramic, combinations of metal with plastic or ceramic, andother suitable materials or combinations of materials that will beapparent to those of ordinary skill in the art in view of the teachingsherein. Additionally, rigid portion (326) in some versions is entirelyrigid, yet in other versions rigid portion (326) can be resilient to alesser extent than deflectable portion (328).

In the illustrated version of FIGS. 13 and 14, metal portion (326)comprises an underside surface (332) that is generally flat or planar,and a top surface (334) that is similarly generally flat or planar.Metal portion (326) further comprises an opening (336) that extendsthrough metal portion (326) from top surface (334) to underside surface(332). Additionally, metal portion (326) comprises a neck region (338),a head region (340) that extends distally from neck region (338), andshoulders (342) at the transition between neck region (338) and headregion (340). In the present example neck region (338) extends from body(330) of anvil (318). With this arrangement, metal portion (326)provides securing features or interfaces, such as opening (336) andshoulders (342), where elastomeric portion (328) can connect with metalportion (326) in a secure fashion using an overmolding process.

FIG. 15 illustrates a cross section view of anvil (318) just proximal todistal tip (319). As shown, anvil (318) comprises a longitudinal slot(344) that divides six rows of staple forming pockets (346) into twosets of three rows each. Slot (344) and staple forming pockets (346) arestructurally and functionally similar to slot (42) and staple formingpockets (53) described above with respect to anvil (18). Slot (344)comprises a “t” shaped cross section as shown in FIG. 15. Referringagain to FIGS. 13 and 14, opening (336) in metal portion (326) ispositioned adjacent to a laterally extending portion of slot (344). Inview of the teachings herein, other ways to configure metal portion(326) for suitable connection with elastomeric portion (328) using anovermolding process will be apparent to those of ordinary skill in theart.

Elastomeric portion (328) is molded onto metal portion (326) and in themolding process is imparted with an angled configuration such thatelastomeric portion (328) defines a plane that intersects and is notco-planar with a plane defined by body (330) of anvil (318). In thismanner, elastomeric portion (328) is formed with a bias to maintain itsangled configuration unless some other force is imparted ontoelastomeric portion (328) causing it to deflect from its initial angledposition. During the molding process, elastomeric material flows throughand fills opening (336) in metal portion (326). Elastomeric materialalso flows around and adjacent to shoulders (342). In this manner,elastomer portion (328) is securely connected with metal portion (326)during the overmolding process. Elastomeric portion (328) may compriserubber, plastic, or any other suitable natural or synthetic materialhaving the desired elastomeric properties that will allow distal tip(319) to deform when subject to force, yet resiliently return to itsinitial angled state when the force is no longer applied or present.During the molding process, a stop member (not shown) may be insertedinto a slot (349) formed distally to slot (344), to prevent theelastomeric material from entering slot (344). In view of the teachingsherein, other ways to configure elastomeric portion (328) for suitableconnection with metal portion (326) using an overmolding process will beapparent to those of ordinary skill in the art.

With the configuration for distal tip (319) as described above and shownin FIGS. 13 and 14, the extension of metal portion (326) into the regionof distal tip (319) defines a deflection zone (348). Deflection zone(348) coincides with a rigid portion of distal tip (319) located at aproximal end of distal tip (319). With this area of increased rigidity,distal tip (319) will deflect, for example as shown in FIG. 12A, withdeflection zone (348) serving as a pivot point or location about whichthe remainder of distal tip (319) rotates during deflection. In view ofthe teachings herein, those of ordinary skill in the art will appreciateother ways in which to modify distal tip (319) to alter, modify, orcontrol deflection zone (348) such that a desired deflection of distaltip (319) is achieved.

IV. Method of Surgical Stapling with End Effector Component Having aCurved Tip

A. Exemplary Configurations for End Effectors with ElasticallyDeformable Placement Tips

With end effectors having bent or angled elastic deformable tips, alsoreferred to as placement tips, such as those described above withrespect to end effectors (312, 412), the deformable tips can deflectduring use. As described above, the elastic deformable tip can belocated on the anvil, like with anvil (318). In other versions, theelastic deformable tip can be located on the cartridge. Additionally,while end effectors (12, 212, 312, 412) described above are discussed asincluding a lower jaw (16, 216) opposite to the anvil (18, 218, 318), insome versions the end effectors comprise an upper jaw and a lower jaw,where the anvil may be located on either jaw, and the cartridge may belocated on either jaw opposite the jaw with the anvil. Furthermore,either jaw may include the elastic deformable tip, which can be part of,or associated with, the anvil or the cartridge. The following paragraphsdescribe several exemplary end effectors, usable with instruments (10,310) and other instruments, that include a lower jaw, an upper jaw, andan elastic deformable tip or placement tip. These exemplary endeffectors are shown and described in a variety of ways that are notintended to be mutually exclusive of each other. Instead, in manyinstances the features of one version applies equally to anotherversion, as will be appreciated by those of ordinary skill in the art inview of the teachings herein.

In some versions that will be shown and described, the deflection of thedeformable tip changes an angle of the deformable tip relative to alongitudinal axis defined by the jaw with which the deformable tip islocated when comparing states when the end effector is in open versusclosed states. In some versions that will be shown and described, thedeflection of the deformable tip changes an angle of the deformable tiprelative to the nose of the cartridge when the end effector is loaded orengages tissue versus when the end effector is not loaded or not engagedwith tissue. In some versions that will be shown and described, theplacement tip of one of the end effector jaws may adopt certainpositions relative to the other of the end effector jaws when indeflected versus non-deflected states. In some versions that will beshown and described, the end effector components are configured withcertain placement tip end and/or width profiles. Lastly, in someversions that will be shown and described, the end effector componentsare configured with certain underside surface configurations and/orgaps.

The end effectors described below can each be configured for use withinstruments (10, 310) described above. For instance, it will beappreciated that each of the end effectors described below may be usedin place of end effector (12) shown in FIG. 1 or in place of endeffector (312) shown in FIG. 11. In some versions, each of the endeffectors described below may be integrally formed with shaft (22) oralternatively may be separately formed and then combined. In someversions, each of the end effectors described below may be provided foruse in robotic systems. In such robotic systems, modular shaft (322)having any of the end effectors described below may be attachable to aportion of the robotic system for use such that handle portion (320) isreplaced by components of the robotic system. Still in other examples,each of the end effectors described below may be adapted for use with arobotic system in a manner where any of the end effectors describedbelow connects with the robotic system without necessarily connectingthe entire modular shaft (322). In view of the teachings herein, otherways to incorporate each of the end effectors described below into auser operated or robotic operated instrument will be apparent to thoseof ordinary skill in the art.

1. Exemplary Angles in Open and Closed States

Referring now to FIGS. 16 and 17, an enlarged view of an end effector(512) is shown. End effector (512) is configured for use withinstruments (10, 310) and/or for robotic use as described above. Endeffector (512) comprises an upper jaw (514) and a lower jaw (516). Inthe present example, upper jaw (514) comprises a body (517) havingdistal tip or placement tip (519) that is bent or angled and elasticallydeformable. Body (517), excluding placement tip (519), defines alongitudinal axis (LA1). Placement tip (519) defines another axis (A2).In the present example, longitudinal axis (LA1) extends parallel to anunderside surface (520) of body (517) of upper jaw (514). Similarly,axis (A2) extends parallel to an underside surface (522) of placementtip (519).

As shown in FIG. 16, end effector (512) is in an open position or statewith no tissue or other object contacting end effector (512). A firstangle (θ3) is defined by the intersection of longitudinal axis (LA1) ofbody (517) and axis (A2) of placement tip (519). Stated another way,first angle (θ3) is defined by the intersection of a plane extendingalong underside surface (520) of body (517) and a plane extending alongunderside surface (522) of placement tip (519).

As shown in FIG. 17, end effector (512) has been moved to a closedposition and still in an unloaded state without tissue contacting endeffector (512). However, in the closed position, placement tip (519) ofupper jaw (514) contacts lower jaw (516). With this contact and theelastically deformable nature of placement tip (519), placement tip(519) deflects from its position relative to body (517) as shown in FIG.16. In this deflected position or state, a second angle (θ4) is definedby the intersection of longitudinal axis (LA1) of body (517) and axis(A2) of placement tip (519). Stated another way, second angle (θ4) isdefined by the intersection of a plane extending along underside surface(520) of body (517) and a plane extending along underside surface (522)of placement tip (519).

With the deflection of placement tip (519), second angle (θ4) is not thesame as first angle (θ3). For instance, with the illustrated deflectionin FIG. 17, the lower jaw (516) contacts the underside of placement tip(519) such that placement tip (519) pivots upward away from lower jaw(516) such that the second angle (θ4) is greater than the first angle(θ3). In the present example, end effector (512) defines a pivot point(524) about which placement tip (519) pivots relative to body (517).More specifically, pivot point (524) occurs at the location whereunderside surface (520) of body (517) and underside surface (522) ofplacement tip (519) meet. With this configuration, end effector (512)comprises a placement tip (519) extending from the distal end of upperjaw (514). Placement tip (519) comprises a first angle (θ3) with respectto the axis of body (517) of upper jaw (514), or longitudinal axis(LA1), when end effector (512) is in the open position. Placement tip(519) further comprises a second angle (θ4) with respect to the axis ofbody (517) of upper jaw (514), when end effector (512) is in the closedposition, and second angle (θ4) differs from first angle (θ3).

In view of the teachings herein, various ways to modify end effector(512) and the deflection of placement tip (519) such that other anglesare achieved for second angle (θ4) when end effector (512) is in aclosed position will be apparent to those of ordinary skill in the artin view of the teachings herein. By way of example only, and notlimitation, one such modification would be to alter the relationship ofthe contact that placement tip (519) makes with lower jaw (516) when endeffector (512) is closed. In the present example, lower jaw (516)comprises a nose portion (526) at a distal end of lower jaw (516).Furthermore, nose portion (526) comprises a top surface (528) thatdefines a plane having a slope relative to a longitudinal axis (LA2) oflower jaw (516). This slope can impact the deflection of the placementtip (519) thereby causing changes in the second angle (θ4). By way ofanother example only, and not limitation, another such modificationwould be to include features on top surface (528) that direct and/orimpact the deflection of the placement tip (519) thereby causing changesin the second angle (θ4).

In some versions, upper jaw (514) comprises an anvil (518) similar toanvils (18, 218, 318) as described above. In such versions, anvil (518)comprises body (517) and placement tip (519). Also in such versions,opposite anvil (518), lower jaw (516) comprises a staple cartridge (537)with nose portion (526). With this configuration, end effector (512)comprises placement tip (519) extending from the distal end of anvil(518). Placement tip (519) comprises a first angle (03) with respect toanvil (518) axis or longitudinal axis (LA1) when end effector (512) isin the open position. Placement tip (519) further comprises a secondangle (θ4) with respect to anvil (518) axis or longitudinal axis (LA1)when end effector (512) is in the closed position, and second angle (θ4)differs from first angle (θ3) as described above. In some otherversions, the location of anvil (518) and cartridge (537) can beswitched such that lower jaw (516) comprises anvil (518) while upper jaw(514) comprises staple cartridge (537).

2. Exemplary Angles with Deflection by Tissue

Referring now to FIGS. 18 and 19, an enlarged view of an end effector(612) is shown. End effector (612) is configured for use withinstruments (10, 310) and/or for robotic use as described above. Endeffector (612) comprises an upper jaw (614) and a lower jaw (616). Inthe present example, upper jaw (614) comprises a body (617) havingplacement tip (619) that is bent or angled and elastically deformable.Body (617), excluding the placement tip (619), defines a longitudinalaxis (LA3) that extends along an underside surface (620) of body (617).Placement tip (619) defines another axis (A3) that extends along anunderside surface (622) of placement tip (619). Furthermore, in thepresent example, lower jaw (616) comprises a tapered nose portion (626)at a distal end of lower jaw (616). Nose portion (626) defines an axis(A4) that extends along a top surface (628) of nose portion (626).

As shown in FIG. 18, end effector (612) is in an unloaded state with notissue or other object between upper jaw (614) and lower jaw (616). Athird angle (θ5) is defined by the intersection of longitudinal axis(LA3) of body (617) and axis (A3) of placement tip (619). Stated anotherway, third angle (θ5) is defined by the intersection of a planeextending along underside surface (620) of body (617) and a planeextending along underside surface (622) of placement tip (619) when endeffector (612) is in an unloaded state. Similarly, when end effector(612) is in an unloaded state with no tissue or other object betweenupper jaw (614) and lower jaw (616) as shown in FIG. 18, a fifth angle(α1) is defined by the intersection of axis (A3) of placement tip (619)and axis (A4) of nose portion (626). Stated another way, fifth angle(α1) is defined by the intersection of a plane extending along undersidesurface (622) of placement tip (619) and a plane extending along topsurface (628) of nose portion (626) when end effector (612) is in anunloaded state. As also shown in the present example of FIG. 18, withend effector (612) closed and in an unloaded state, an end (630) ofplacement tip (619) is located proximal to an end (632) of nose portion(626).

As shown in FIG. 19, end effector (612) has been moved to a closedposition and loaded state with tissue between upper jaw (614) and lowerjaw (616) of end effector (612). With tissue between jaws (614, 616) andthe elastically deformable nature of placement tip (619), placement tip(619) deflects from its position relative to body (617). In thisdeflected position or state, a fourth angle (θ6) is defined by theintersection of longitudinal axis (LA3) of body (617) and axis (A3) ofplacement tip (619). Stated another way, fourth angle (θ6) is defined bythe intersection of a plane extending along underside surface (620) ofbody (617) and a plane extending along underside surface (622) ofplacement tip (619) when end effector (612) is in a loaded state.Similarly, when end effector (612) is in the loaded state with tissuebetween upper jaw (614) and lower jaw (616) as shown in FIG. 19, a sixthangle (α2) is defined by the intersection of axis (A3) of placement tip(619) and axis (A4) of nose portion (626). Stated another way, sixthangle (α2) is defined by the intersection of a plane extending alongunderside surface (622) of placement tip (619) and a plane extendingalong top surface (628) of nose portion (626) when end effector (612) isin a loaded state. As also shown in the present example of FIG. 19, withend effector (612) closed and in a loaded state, end (630) of placementtip (619) is located distal to end (632) of nose portion (626).

With the deflection of placement tip (619) in the loaded state of FIG.19 versus the unloaded state of FIG. 18, fourth angle (α6) is not thesame as third angle (α5). For instance, with the illustrated deflectionin FIG. 19, the tissue contacts the underside of placement tip (619)such that placement tip (619) pivots upward away from lower jaw (616)such that the fourth angle (α6) is greater than the third angle (α5). Inthe present example, end effector (612) defines a pivot point (624)about which placement tip (619) pivots relative to body (617). Morespecifically, pivot point (624) occurs at the location where undersidesurface (620) of body (617) and underside surface (622) of placement tip(619) meet. With this configuration, end effector (612) comprises aplacement tip (619) extending from the distal end of upper jaw (614).Placement tip (619) comprises a third angle (θ5) with respect to theaxis of body (617) of upper jaw (614), or longitudinal axis (LA3), whenend effector (612) is in the closed and unloaded state. Placement tip(619) further comprises a fourth angle (θ6) with respect to the axis ofbody (617) of upper jaw (614), when end effector (612) is in the closedposition and loaded state, and fourth angle (θ6) differs from thirdangle (θ5). Similarly with this configuration, end effector (612)comprises placement tip (619) having an undeflected state and adeflected state. In the undeflected state placement tip (619) and noseportion (626) define fifth angle (α1), and in the deflected stateplacement tip (619) and nose portion (626) define sixth angle (α2) thatdiffers from fifth angle (α1).

In view of the teachings herein, various ways to modify end effector(612) and the deflection of placement tip (619) such that other anglesare achieved for fourth angle (θ6) and sixth angle (α2) when endeffector (612) is in a closed and loaded state will be apparent to thoseof ordinary skill in the art in view of the teachings herein. By way ofexample only, and not limitation, one such modification would be toalter the taper of nose portion (626) so that axis (A4) that extendsalong top surface (628) of nose portion (626) is steeper or shallower.By way of another example only, and not limitation, another suchmodification would be to include features on top surface (628) thatdirect the tissue held between the nose portion (626) and placement tip(619) to alter the force applied to placement tip (619) and thereby thedeflection of placement tip (619) to cause changes in fourth angle (θ6)and sixth angle (α2) when end effector (612) is in a closed and loadedstate.

In some versions, upper jaw (614) comprises an anvil (618) similar toanvils (18, 218, 318) as described above. In such versions, anvil (618)comprises body (617) and placement tip (619). Also in such versions,opposite anvil (618), lower jaw (616) comprises a staple cartridge (637)with nose portion (626). With this configuration, end effector (612)comprises placement tip (619) extending from the distal end of anvil(618). Placement tip (619) comprises a third angle (θ5) with respect toanvil (618) axis or longitudinal axis (LA3) when end effector (612) isin the closed and unloaded state. Placement tip (619) further comprisesa fourth angle (θ6) with respect to anvil (618) axis or longitudinalaxis (LA3) when end effector (612) is in the closed and loaded state,and fourth angle (θ6) differs from third angle (θ5) as described above.Similarly with this configuration, end effector (612) comprisesplacement tip (619) extending from the distal end of anvil (618), andnose portion (619) at a distal end of cartridge (637), where endeffector (612) has an undeflected state and a deflected state. In theundeflected state placement tip (619) of anvil (618), and nose portion(626) of cartridge (637), define fifth angle (α1). In the deflectedstate placement tip (619) of anvil (618), and nose portion (626) ofcartridge (637) define sixth angle (α2) that differs from fifth angle(α1). In some other versions, the location of anvil (618) and cartridge(637) can be switched such that lower jaw (616) comprises anvil (618)while upper jaw (614) comprises staple cartridge (637).

3. Exemplary Tip Positions in Deflected and Non-Deflected States

As described above with respect to FIGS. 18 and 19, placement tip (619)is configured to deflect when end effector (612) is loaded, and suchdeflection occurs in a manner where end (630) of placement tip (619)changes its relative placement or location with respect to end (632) ofnose portion (626) of cartridge (637). As shown in FIGS. 18 and 19, end(630) is proximal to end (632) when end effector (612) is unloaded suchthat there is an absence of tissue between upper jaw (614) and lower jaw(616). And when end effector (612) is loaded with tissue between upperjaw (614) and lower jaw (616), end (630) moves distally such that end(630) is distal to end (632).

Referring now to FIG. 20, an enlarged view of an end effector (712) isshown. End effector (712) is configured for use with instruments (10,310) and/or for robotic use as described above. End effector (712)comprises upper jaw (714) and lower jaw (716). Lower jaw (716) comprisesnose portion (726) and end (732). Lower jaw (716) further comprises deck(772). Upper jaw (714) comprises a body (717) and a placement tip (719).Placement tip (719) has a bent or angled configuration and iselastically deformable as described above. Placement tip (719) comprisesend (730) at its distal-most portion.

As shown in FIG. 20, a first reference plane (P1) is defined by deck(772), and generally extends parallel with a longitudinal axis of lowerjaw (716). A second reference plane (P2) passes through end (732) ofnose portion (726) such that second reference plane (P2) is orthogonalto first reference plane (P1). As shown in FIG. 20, the location orplacement of end (732) of placement tip (719) can be shown and describedrelative to first reference plane (P1) and second reference plane (P2).In other words, the location or placement of end (730) of placement tip(719) can be described as being proximal to, even with, or distal to end(732) of nose portion (726) of lower jaw (716) as illustrated by secondreference plane (P2). At the same time, the location or placement of end(730) of placement tip (719) can be described as being above, even with,or below deck (772) of lower jaw (716) as illustrated by first referenceplane (P1).

Referring now to FIG. 21, an enlarged view of another end effector (812)is shown with reference markings that define multiple zones that can beused to describe the location or placement of the end of the placementtip of an exemplary end effector. End effector (812) is configured foruse with instruments (10, 310) and/or for robotic use as describedabove. As with end effector (712) and FIG. 20, end effector (812) ofFIG. 21 also comprises first reference plane (P1) and second referenceplane (P2). Additionally, a third reference plane (P3) is defined by andextends along a bottom surface (834) of lower jaw (816). Third referenceplane (P3) in the present example is parallel with first reference plane(P1) and also orthogonal to second reference plane (P2). With thisconfiguration, as shown in FIG. 21, six zones are defined by theintersections of first and third reference planes (P1, P3) with secondreference plane (P2).

A first zone (Z1) is shown as the region above deck (872) of lower jaw(816) (corresponding with first reference plane (P1)) and proximal toend (832) of nose portion (826) (corresponding with second referenceplane (P2)). A second zone (Z2) is shown as the region above deck (872)of lower jaw (816) (corresponding with first reference plane (P1)) anddistal to end (832) of nose portion (826) (corresponding with secondreference plane (P2)). A third zone (Z3) is shown as the region belowdeck (872) of lower jaw (816) (corresponding with first reference plane(P1)) yet above bottom surface (834) of lower jaw (816) (correspondingwith third reference plane (P3)), and proximal to end (832) of noseportion (826) (corresponding with second reference plane (P2)). A fourthzone (Z4) is shown as the region below deck (872) of lower jaw (816)(corresponding with first reference plane (P1)) yet above bottom surface(834) of lower jaw (816) (corresponding with third reference plane(P3)), and distal to end (832) of nose portion (826) (corresponding withsecond reference plane (P2)). A fifth zone (Z5) is shown as the regionbelow bottom surface (834) of lower jaw (816) (corresponding with thirdreference plane (P3)), and proximal to end (832) of nose portion (826)(corresponding with second reference plane (P2)). A sixth zone (Z6) isshown as the region below bottom surface (834) of lower jaw (816)(corresponding with third reference plane (P3)), and distal to end (832)of nose portion (826) (corresponding with second reference plane (P2)).

Using this reference system, several exemplary end effectors will now bedescribed that illustrate various locations or placements for the end ofthe placement tip when the end effector is in a closed and unloadedstate. Referring to FIG. 22A, an enlarged view of another end effector(912) is shown in a closed and unloaded state. End effector (912) isconfigured for use with instruments (10, 310) and/or for robotic use asdescribed above. End effector (912) comprises an upper jaw (914) and alower jaw (916). Upper jaw (914) comprises a body (917) and a placementtip (919). At its distal-most portion, placement tip (919) comprises anend (930). As shown, placement tip (919) has a bent or angledconfiguration. With the illustrated configuration, placement tip (919)extends through first zone (Z1), and the location of end (930) ofplacement tip (919) is in third zone (Z3). In view of the teachingsherein, it will be apparent to those of ordinary skill in the art thatwhen end effector (912) is in a closed and loaded state that thelocation of end (930) of placement tip (919) may deflect yet remain inthird zone (Z3). However, it will also be apparent to those of ordinaryskill in the art in view of the teachings herein that placement tip(919) may deflect such that end (930) of placement tip (919) changes itslocation in the closed and loaded state to another one of the zones.

Referring now to FIG. 22B, an enlarged view of another end effector(1012) is shown in a closed and unloaded state. End effector (1012) isconfigured for use with instruments (10, 310) and/or for robotic use asdescribed above. End effector (1012) comprises an upper jaw (1014) and alower jaw (1016). Upper jaw (1014) comprises a body (1017) and aplacement tip (1019). At its distal-most portion, placement tip (1019)comprises an end (1030). As shown, placement tip (1019) has a curvedconfiguration. With the illustrated configuration, placement tip (1019)extends through first zone (Z1), and the location of end (1030) ofplacement tip (1019) is in third zone (Z3). In view of the teachingsherein, it will be apparent to those of ordinary skill in the art thatwhen end effector (1012) is in a closed and loaded state that thelocation of end (1030) of placement tip (1019) may deflect yet remain inthird zone (Z3). However, it will also be apparent to those of ordinaryskill in the art in view of the teachings herein that placement tip(1019) may deflect such that end (1030) of placement tip (1019) changesits location in the closed and loaded state to another one of the zones.

Referring now to FIG. 22C, an enlarged view of another end effector(1112) is shown in a closed and unloaded state. End effector (1112) isconfigured for use with instruments (10, 310) and/or for robotic use asdescribed above. End effector (1112) comprises an upper jaw (1114) and alower jaw (1116). Upper jaw (1114) comprises a body (1117) and aplacement tip (1119). At its distal-most portion, placement tip (1119)comprises an end (1130). As shown, placement tip (1119) has a bent orangled configuration. With the illustrated configuration, placement tip(1119) extends through first and third zones (Z1, Z3) and the locationof end (1130) of placement tip (1119) is in fourth zone (Z4). In view ofthe teachings herein, it will be apparent to those of ordinary skill inthe art that when end effector (1112) is in a closed and loaded statethat the location of end (1130) of placement tip (1119) may deflect yetremain in fourth zone (Z4). However, it will also be apparent to thoseof ordinary skill in the art in view of the teachings herein thatplacement tip (1119) may deflect such that end (1130) of placement tip(1119) changes its location in the closed and loaded state to anotherone of the zones.

Referring now to FIG. 22D, an enlarged view of another end effector(1212) is shown in a closed and unloaded state. End effector (1212) isconfigured for use with instruments (10, 310) and/or for robotic use asdescribed above. End effector (1212) comprises an upper jaw (1214) and alower jaw (1216). Upper jaw (1214) comprises a body (1217) and aplacement tip (1219). At its distal-most portion, placement tip (1219)comprises an end (1230). As shown, placement tip (1219) has a curvedconfiguration. With the illustrated configuration, placement tip (1219)extends through first, second, third, fourth, and sixth zones (Z1, Z2,Z3, Z4, Z6) and the location of end (1230) of placement tip (1219) is infifth zone (Z5). Out of the six total zones, placement tip (1230) passesthrough all of them, albeit third zone (Z3) is substantially void ofplacement tip (1230). In view of the teachings herein, it will beapparent to those of ordinary skill in the art that when end effector(1212) is in a closed and loaded state that the location of end (1230)of placement tip (1219) may deflect yet remain in fifth zone (Z5).However, it will also be apparent to those of ordinary skill in the artin view of the teachings herein that placement tip (1219) may deflectsuch that end (1230) of placement tip (1219) changes its location in theclosed and loaded state to another one of the zones.

Referring now to FIG. 22E, an enlarged view of another end effector(1312) is shown in a closed and unloaded state. End effector (1312) isconfigured for use with instruments (10, 310) and/or for robotic use asdescribed above. End effector (1312) comprises an upper jaw (1314) and alower jaw (1316). Upper jaw (1314) comprises a body (1317) and aplacement tip (1319). At its distal-most portion, placement tip (1319)comprises an end (1330). As shown, placement tip (1319) has a bent orangled configuration. With the illustrated configuration, placement tip(1319) extends through first, third, and fourth zones (Z1, Z3, Z4) andthe location of end (1330) of placement tip (1319) is in sixth zone(Z6). In view of the teachings herein, it will be apparent to those ofordinary skill in the art that when end effector (1312) is in a closedand loaded state that the location of end (1330) of placement tip (1319)may deflect yet remain in sixth zone (Z6). However, it will also beapparent to those of ordinary skill in the art in view of the teachingsherein that placement tip (1319) may deflect such that end (1330) ofplacement tip (1319) changes its location in the closed and loaded stateto another one of the zones.

Referring now to FIG. 22F, an enlarged view of another end effector(1412) is shown in a closed and unloaded state. End effector (1412) isconfigured for use with instruments (10, 310) and/or for robotic use asdescribed above. End effector (1412) comprises an upper jaw (1414) and alower jaw (1416). Upper jaw (1414) comprises a body (1417) and aplacement tip (1419). At its distal-most portion, placement tip (1419)comprises an end (1430). As shown, placement tip (1419) has amulti-angled configuration. With the illustrated configuration,placement tip (1419) extends through first, third, and fourth zones (Z1,Z3, Z4) and the location of end (1430) of placement tip (1419) is insixth zone (Z6). In view of the teachings herein, it will be apparent tothose of ordinary skill in the art that when end effector (1412) is in aclosed and loaded state that the location of end (1430) of placement tip(1419) may deflect yet remain in sixth zone (Z6). However, it will alsobe apparent to those of ordinary skill in the art in view of theteachings herein that placement tip (1419) may deflect such that end(1430) of placement tip (1419) changes its location in the closed andloaded state to another one of the zones.

Referring now to FIG. 22G, an enlarged view of another end effector(1512) is shown in a closed and unloaded state. End effector (1512) isconfigured for use with instruments (10, 310) and/or for robotic use asdescribed above. End effector (1512) comprises an upper jaw (1514) and alower jaw (1516). Upper jaw (1514) comprises a body (1517) and aplacement tip (1519). At its distal-most portion, placement tip (1519)comprises an end (1530). As shown, placement tip (1519) has a bent orangled configuration. At its proximal end, placement tip (1519)comprises a step (1591) such that body (1517) is offset from step (1591)of placement tip (1519). With the illustrated configuration, placementtip (1519) extends through first zone (Z1) and the location of end(1530) of placement tip (1519) is in third zone (Z3). In view of theteachings herein, it will be apparent to those of ordinary skill in theart that when end effector (1512) is in a closed and loaded state thatthe location of end (1530) of placement tip (1519) may deflect yetremain in third zone (Z3). However, it will also be apparent to those ofordinary skill in the art in view of the teachings herein that placementtip (1519) may deflect such that end (1530) of placement tip (1519)changes its location in the closed and loaded state to another one ofthe zones.

As shown in FIG. 22G, end effector (1512) defines a fourth referenceplane (P4) based on the offset of body (1517) from step (1591) ofplacement tip (1519). Also, placement tip (1519) comprises an undersidesurface (1522) that matches the profile of top surface (1528) and deck(1572) of lower jaw (1516). Placement tip (1519) defines pivot point(1524) where underside surface (1522) transitions from matching theprofile of top surface (1528) of lower jaw (1516) to matching deck(1572) of lower jaw (1516). As shown in the illustrated version, endeffector (1512) defines a first distance (D1) as extending from pivotpoint (1524) proximally to the proximal-most end of step (1591). Firstdistance (D1) can be consider as representing the length of placementtip (1519) that overlaps deck (1572) of lower jaw (1516). In view of theteaching herein, various ways to modify or alter end effector (1512) andfirst distance (D1) to achieve greater or smaller overlaps of placementtip (1519) and deck (1572) will be apparent to those of ordinary skillin the art.

The above paragraphs describe a reference system where various referenceplanes are used to define zones relative to an end effector.Specifically, the various reference planes are relative to an endeffector's lower jaw's deck, distal-most end, and bottom surface. Thisreference system is applicable to other versions of end effectors shownand described herein, other than those described above in FIGS. 22A-22G.For example, it is clear from FIG. 17 that end effector (512) comprisesplacement tip (519) that presents its distal-most end in third zone(Z3). Similarly, FIG. 18 illustrates that end effector (612) comprisesplacement tip (619) that presents its distal-most end also in third zone(Z3). With respect to end effectors (512, 612) and FIGS. 17 and 18, bothend effectors (512, 612) are shown in closed and unloaded states.Referring to FIG. 19, end effector (612) is shown in a closed and loadedstate. As illustrated, with end effector (612) in a closed and loadedstate, placement tip (619) deflects such that the distal-most end ofplacement tip (619) is located mostly in second zone (Z2) with a smallerportion located in fourth zone (Z4). In view of the teachings herein,various ways to configure an end effector to locate an end of aplacement tip in a desired position under various conditions, i.e.open/closed and loaded/unloaded, will be apparent to those of ordinaryskill in the art.

4. Exemplary Shapes for Elastically Deformable Placement Tips

As described above, placement tips for end effectors can have a bent orangled configuration as well as a curved configuration. This is shown inthe several side views of FIGS. 22A-22G for instance. In combinationwith these various options for placement tips of an end effector,further options for the shape of the placement tip exist. As will bedescribed below, placement tips can be configured with various distalend profiles, width profiles, and underside surface geometries. Itshould be understood that the various shapes described below related todistal end profile, width profile, and underside surface geometry can becombined in a single placement tip. For instance, any of the distal endprofiles shown and described can be used in a placement tip having anyof the width profiles shown and described, and further such a placementtip can have any of the underside surface geometries shown anddescribed.

a. Distal End Profiles

FIGS. 23A-23F depict exemplary enlarged placement tip portions that showvarious distal end profiles for the placement tip. Referring to FIG.23A, an end effector comprises a placement tip (1619). As shown in thetop view of FIG. 23A, placement tip (1619) comprises a distal end (1630)having a round profile. Placement tip (1619) is configurable such thatit may be positioned on either an upper jaw or lower jaw of the endeffector. Furthermore, placement tip (1619) is configurable such that itmay be part of an anvil or part of a staple cartridge. In view of theteachings herein, it will be apparent to those of ordinary skill in theart that this round distal end profile of placement tip (1619) can beused with any of the placement tips of the end effectors describedherein.

FIG. 23B depicts an end effector comprising a placement tip (1719). Asshown in the top view of FIG. 23B, placement tip (1719) comprises adistal end (1730) having an angled and pointed profile. In this example,because placement tip (1719) is comprises of an elastomeric anddeflectable material, placement tip (1719) is still configured as anatraumatic tip despite its pointed profile. Placement tip (119) isconfigurable such that it may be positioned on either an upper jaw orlower jaw of the end effector. Furthermore, placement tip (119) isconfigurable such that it may be part of an anvil or part of a staplecartridge. In view of the teachings herein, it will be apparent to thoseof ordinary skill in the art that this angled and pointed distal endprofile of placement tip (119) can be used with any of the placementtips of the end effectors described herein.

FIG. 23C depicts an end effector comprising a placement tip (1819). Asshown in the top view of FIG. 23C, placement tip (1819) comprises adistal end (1830) having a toothed profile. Placement tip (1819) isconfigurable such that it may be positioned on either an upper jaw orlower jaw of the end effector. Furthermore, placement tip (1819) isconfigurable such that it may be part of an anvil or part of a staplecartridge. In view of the teachings herein, it will be apparent to thoseof ordinary skill in the art that this toothed distal end profile ofplacement tip (1819) can be used with any of the placement tips of theend effectors described herein.

FIG. 23D depicts an end effector comprising a placement tip (1919). Asshown in the top view of FIG. 23D, placement tip (1919) comprises adistal end (1930) having a flared profile. Placement tip (1919) isconfigurable such that it may be positioned on either an upper jaw orlower jaw of the end effector. Furthermore, placement tip (1919) isconfigurable such that it may be part of an anvil or part of a staplecartridge. In view of the teachings herein, it will be apparent to thoseof ordinary skill in the art that this flared distal end profile ofplacement tip (1919) can be used with any of the placement tips of theend effectors described herein.

FIG. 23E depicts an end effector comprising a placement tip (2019). Asshown in the top view of FIG. 23E, placement tip (2019) comprises adistal end (2030) having an orb profile. Placement tip (2019) isconfigurable such that it may be positioned on either an upper jaw orlower jaw of the end effector. Furthermore, placement tip (2019) isconfigurable such that it may be part of an anvil or part of a staplecartridge. In view of the teachings herein, it will be apparent to thoseof ordinary skill in the art that this orb distal end profile ofplacement tip (2019) can be used with any of the placement tips of theend effectors described herein.

FIG. 23F depicts an end effector comprising a placement tip (2119). Asshown in the top view of FIG. 23F, placement tip (2119) comprises adistal end (2130) having an asymmetric profile. In this manner, end(2130) extends distally longer on one side than the other such that end(2130) is angled. Placement tip (2119) is configurable such that it maybe positioned on either an upper jaw or lower jaw of the end effector.Furthermore, placement tip (2119) is configurable such that it may bepart of an anvil or part of a staple cartridge. In view of the teachingsherein, it will be apparent to those of ordinary skill in the art thatthis asymmetric distal end profile of placement tip (2119) can be usedwith any of the placement tips of the end effectors described herein.While several distal end profiles for placement tips of an end effectorhave been shown and described above, other distal end profiles forplacement tips of an end effector will be apparent to those of ordinaryskill in the art in view of the teachings herein.

b. Width Profiles

FIGS. 24A-24E depict exemplary enlarged placement tip portions that showvarious width profiles for the placement tip. Referring to FIG. 24A, anend effector comprises a placement tip (2219). As shown in the top viewof FIG. 24A, placement tip (2219) comprises distal sides (2229) leadingto distal end (2230) where distal sides (2229) define a width profilethat is angled. Placement tip (2219) is configurable such that it may bepositioned on either an upper jaw or lower jaw of the end effector.Furthermore, placement tip (2219) is configurable such that it may bepart of an anvil or part of a staple cartridge. In view of the teachingsherein, it will be apparent to those of ordinary skill in the art thatthis angled width profile of placement tip (2219) can be used with anyof the placement tips of the end effectors described herein.

FIG. 24B depicts an end effector comprising a placement tip (2319). Asshown in the top view of FIG. 24B, placement tip (2319) comprises distalsides (2329) leading to distal end (2330) where distal sides (2329)define a width profile that is stepped. Placement tip (2319) isconfigurable such that it may be positioned on either an upper jaw orlower jaw of the end effector. Furthermore, placement tip (2319) isconfigurable such that it may be part of an anvil or part of a staplecartridge. In view of the teachings herein, it will be apparent to thoseof ordinary skill in the art that this stepped width profile ofplacement tip (2319) can be used with any of the placement tips of theend effectors described herein.

FIG. 24C depicts an end effector comprising a placement tip (2419). Asshown in the top view of FIG. 24C, placement tip (2419) comprises distalsides (2429) leading to distal end (2430) where distal sides (2429)define a width profile that is asymmetric such that distal sides (2429)are not symmetrically oriented, and in this instance are angled tovarying degrees. Placement tip (2419) is configurable such that it maybe positioned on either an upper jaw or lower jaw of the end effector.Furthermore, placement tip (2419) is configurable such that it may bepart of an anvil or part of a staple cartridge. In view of the teachingsherein, it will be apparent to those of ordinary skill in the art thatthis asymmetric width profile of placement tip (2419) can be used withany of the placement tips of the end effectors described herein.

FIG. 24D depicts an end effector comprising a placement tip (2519). Asshown in the top view of FIG. 24D, placement tip (2519) comprises distalsides (2529) leading to distal end (2530) where distal sides (2529)define a width profile that is scalloped with distal end (2530) centeredalong the longitudinal axis of placement tip (2519). In this manner, oneof distal sides (2529) has a curvature that is concave while the otherhas a curvature that is convex. Placement tip (2519) is configurablesuch that it may be positioned on either an upper jaw or lower jaw ofthe end effector. Furthermore, placement tip (2519) is configurable suchthat it may be part of an anvil or part of a staple cartridge. In viewof the teachings herein, it will be apparent to those of ordinary skillin the art that this scalloped width profile of placement tip (2519) canbe used with any of the placement tips of the end effectors describedherein.

FIG. 24E depicts an end effector comprising a placement tip (2619). Asshown in the top view of FIG. 24E, placement tip (2619) comprises distalsides (2629) leading to distal end (2630) where distal sides (2629)define a width profile having bump-outs or lateral protrusions (2631) oneach side. In the illustrated version, a jaw (2616) of end effectoropposite placement tip (2619) is shown in phantom. As shown in thepresent example, the bump-outs (2631) extend outward from jaw (2616),whereas the remaining width of placement tip (2619) is narrower than thewidth of jaw (2616). However, bump-outs (2631) are not required toextend out from the width of jaw (2616) in all versions. Where bump-outs(2631) do extend outward from jaw (2616), placement tip (2619) isconfigured to provide resistance when moving the instrument with the endeffector and placement tip (2619) in and out of a site. Additionally,bump-outs (2631) are configured to dilate an aperture larger whenplacement tip (2619) passes therethrough. Placement tip (2619) isconfigurable such that it may be positioned on either an upper jaw orlower jaw of the end effector. Furthermore, placement tip (2619) isconfigurable such that it may be part of an anvil or part of a staplecartridge. In view of the teachings herein, it will be apparent to thoseof ordinary skill in the art that this width profile of placement tip(2619) having bump-outs (2631) on each side can be used with any of theplacement tips of the end effectors described herein.

FIG. 25 depicts an enlarged top view of a placement tip (2719) of an endeffector, with the placement tip (2719) having a distal end (2730) withan angled and pointed profile and with the placement tip (2719) havingdistal sides (2729) defining a width profile that angled. As describedabove, placement tip (2719) illustrates a combination of the angled andpointed distal end profile of placement tip (1719) of FIG. 23B, with theangled width profile of placement tip (2219) of FIG. 24A. In view of theteachings herein, and as further illustrated by this example, variouscombinations of distal end profiles and width profiles will be apparentto those of ordinary skill in the art.

Placement tip (2719) further illustrates the relationship between theprofile at distal end (2730) compared to the width profile defined bydistal sides (2729). As described above with respect to other examples,placement tips extend from a body of one of an upper jaw or lower jaw ofan end effector. In the present example, placement tip (2719) isunderstood to have a shorter longitudinal dimension, or length, than thebody of the jaw from which it extends. As shown in the illustratedversion, placement tip (2719) can be understood to have a lengthcharacterized by the sum of a first length (L1) and a second length(L2). Although not shown to scale based on the wavy break linesignifying that placement tip (2719) extends proximally further thanshown, it should be understood that first length (L1) is substantiallygreater than second length (L2). When showing and describing the variousdistal end profiles and width profiles of placement tips above in FIGS.23A-23F and 24A-24E, it should be understood that the distal endprofiles as well as the width profiles defined by the distal sides areall included in the length of the placement tips that coincide withsecond length (L2).

Placement tip (2719) further illustrates an example where a planedefined by one of symmetrical distal sides (2729) in combination withanother plane defined by one of proximal sides (2733), form an angle(β1). In this example, as the width profile defined by distal sides(2729) becomes more angular or steeper, angle (β1) increases. When thewidth profile defined by distal sides (2729) becomes less angular, andhence closer to parallel with proximal sides (2733), angle (β1)decreases.

Placement tip (2719) also illustrates an example where a plane definedtangent to the distal-most portion of distal end (2730) in combinationwith a plane defined by one of sides (2735) of distal end (2730), formsan angle (β2). In this example, as the sides (2735) of distal end (2730)become more angular or steeper, angle (β2) increases. When the sides(2735) of distal end (2730) becomes less angular, and hence distal end(2730) becomes more blunt, angle (β2) decreases.

c. Underside Surfaces

Now referring to the side views of FIGS. 26A-26E, various geometries forunderside surfaces of placement tips are shown and described. In someinstances, underside surfaces of placement tips may be referred to asinner surfaces, and these terms should be understood to beinterchangeable. FIG. 26A depicts end effector (2812) comprising upperjaw (2814) and lower jaw (2816). Upper jaw (2814) comprises body (2817)and placement tip (2819) extending distally from body (2817). Placementtip (2819) has a bent or angled configuration and comprises an undersidesurface (2822) that is flat. In this example, underside surface (2822)is also parallel with a top surface (2828) on nose portion (2826) oflower jaw (2816). In this manner, when end effector (2812) is closed andunloaded, underside surface (2822) can contact top surface (2828).

FIG. 26B depicts end effector (2912) comprising upper jaw (2914) andlower jaw (2916). Upper jaw (2914) comprises body (2917) and placementtip (2919) extending distally from body (2917). Placement tip (2919) hasa curved configuration and comprises underside surface (2922) that iscurved. Furthermore, lower jaw (2916) comprises nose portion (2926) witha tapered top surface (2928). The curvature of underside surface (2922)in combination with the tapered top surface (2928) of nose portion(2926) provides placement tip (2919) with point contact when endeffector (2912) is closed and unloaded, as opposed to greater contactarea as with end effector (2812) shown and described above.

FIG. 26C depicts end effector (3012) comprising upper jaw (3014) andlower jaw (3016). Upper jaw (3014) comprises body (3017) and placementtip (3019) extending distally from body (3017). Placement tip (3019) hasa straight configuration and comprises an underside surface (3022) thatis straight. Placement tip (3019) is configured as elasticallydeformable as described above. In this manner, underside surface (3022)of placement tip (3019) extends along the same plane as an undersidesurface (3020) of body (3017) of upper jaw (3014). Furthermore, lowerjaw (3016) comprises nose portion (3026) with a tapered top surface(3028). The straight configuration of underside surface (3022), incombination with the tapered top surface (3028) of nose portion (3026),eliminates placement tip (3019) contact with tapered top surface (3028)when end effector (3012) is closed and unloaded.

FIG. 26D depicts end effector (3112) comprising upper jaw (3114) andlower jaw (3116). Upper jaw (3114) comprises body (3117) and placementtip (3119) extending distally from body (3117). Placement tip (3119) hasa curved configuration and comprises an underside surface (3122) that ismulti-angled. Placement tip (3119) is configured as elasticallydeformable as described above. Furthermore, lower jaw (3116) comprisesnose portion (3126) with a tapered top surface (3128). The multi-anglednature of underside surface (3122) in combination with the tapered topsurface (3128) of nose portion (3126) provides placement tip (3119) withpoint contact when end effector (3112) is closed and unloaded, asopposed to greater contact area as with end effector (3112) shown anddescribed above.

FIG. 26E depicts end effector (3212) comprising upper jaw (3214) havingdual positions and lower jaw (3216). Upper jaw (3214) comprises body(3217) and placement tip (3219) extending distally from body (3217).Placement tip (3219) has a bent or angled configuration when endeffector (3212) is open and unloaded as shown in phantom in FIG. 26E.Placement tip (3219) comprises an underside surface (3222) that includesa curved protrusion (3231). Placement tip (3219) is configured aselastically deformable as described above. Furthermore, lower jaw (3216)comprises nose portion (3226) with a tapered top surface (3228) as wellas deck (3272). The curved protrusion (3231) of underside surface (3222)of placement tip (3219) is configured to act as a pivot structure suchthat placement tip (3219) pivots from its bent or angled orientationshown in phantom to a straight, or at least less bent or angled,orientation in response to curved protrusion (3231) contacting astructure such as deck (3272) when end effector (3212) is closed andwithout tissue between jaws (3214, 3216), or tissue when end effector(3212) is closed and loaded with tissue between jaws (3214, 3216).

5. Exemplary Gaps

The various end effectors described herein provide visualization andguidance features as described above. Additionally, the ability of theplacement tips to deflect or elastically deform can provide benefits inuse during procedure where marching may be required or beneficial. Inaddition to the ability of the placement tips to elastically deform, thepresence or absence of a gap between the placement tip and the oppositejaw's surface can impact visualization and marching. For instance, insome versions with little or no gap, the ability of the placement tip toelastically deform enables use of the end effector in marchingprocedures.

FIGS. 27A and 27B depict portions of end effectors that illustrateexemplary gaps and their configurations. FIG. 27A depicts an enlargedside view of a distal portion of an end effector (3312), showing a gap(3340) between a placement tip (3319) of an upper jaw (3314) and a noseportion (3326) of a lower jaw (3316). In the present example, endeffector (3312) is shown in a closed and unloaded state. Placement tip(3319) comprises underside surface (3322) that is generally parallelwith a top surface (3320) of nose portion (3326) of lower jaw (3316). Inthis manner, gap (3340) is generally of uniform size along undersidesurface (3322) of placement tip (3319) and top surface (3320) of noseportion (3326). With this configuration for gap (3340), and with theelastically deformable nature of placement tip (3319), end effector(3312) is configured for use in procedures where marching is desired.

FIG. 27B depicts an enlarged side view of a distal portion of an endeffector (3412), showing a gap (3440) between a distal end (3430) of aplacement tip (3419) of an upper jaw (3414) and a nose portion (3426) ofa lower jaw (3416). Placement tip (3419) is bent or angled and with endeffector (3412) closed and unloaded as shown, end (3430) contacts ornearly contacts a top surface (3420) of nose portion (3426) of lower jaw(3416). Thus in the present example, gap (3440) is either very small, orin the case where jaws (3414, 3416) touch, gap (3440) is absentaltogether. In versions where gap (3440) is present, as shown gap (3440)increases in size as gap (3440) extends proximally. With thisconfiguration, and with the elastically deformable nature of placementtip (3419), end effector (3412) is configured for use in procedureswhere marching is desired. In view of the teachings herein, other waysto configure end effectors with various gaps to aid in visualization,guidance, and marching will be apparent to those of ordinary skill inthe art.

6. Exemplary Arcuate Side Cross Section

As described above with respect to FIGS. 26B and 26D, some exemplary endeffectors are configured with a placement tip that has an arcuate sidecross section. With placement tips that are elastically deformable ordeflectable, the curvature or degree of curvature of the placement tipchanges based on the clamping force applied to the placement tip. Asdescribed above, having an end effector with a curved placement tip canprovide benefits in visualization and guidance of the end effector inuse. Further, having an end effector with an elastically deformableplacement tip can provide benefits in procedures where marching is usedor desired. Combining curvature with deformability in a placement tipprovides an end effector with desirable visualization and guidanceattributes in a configuration that can be used in marching applicationswithout needing or requiring a gap between the end effector jaws.

Referring now back to FIG. 26B, FIG. 26B depicts end effector (2912)comprising upper jaw (2914) and lower jaw (2916). Upper jaw (2914)comprises body (2917) and placement tip (2919) extending distally frombody (2917). Placement tip (2919) has a curved configuration andcomprises underside surface (2922) that is curved. Furthermore, lowerjaw (2916) comprises nose portion (2926) with a tapered top surface(2928). The curvature of underside surface (2922) in combination withthe tapered top surface (2928) of nose portion (2926) provides placementtip (2919) with point contact when end effector (2912) is closed andunloaded. In this manner, when end effector (2912) is closed andunloaded, there is no gap between upper jaw (2914) and lower jaw (2916).

In some instances, a curved placement tip can be achieved by using amulti-angled underside surface. FIG. 26D depicts such an end effectorwith end effector (3112), which comprises upper jaw (3114) and lower jaw(3116). Upper jaw (3114) comprises body (3117) and placement tip (3119)extending distally from body (3117). Placement tip (3119) has a curvedconfiguration and comprises an underside surface (3122) that ismulti-angled. Placement tip (3119) is configured as elasticallydeformable as described above. Furthermore, lower jaw (3116) comprisesnose portion (3126) with a tapered top surface (3128). The multi-anglednature of underside surface (3122) in combination with the tapered topsurface (3128) of nose portion (3126) provides placement tip (3119) withpoint contact when end effector (3112) is closed and unloaded. In thismanner, when end effector (3112) is closed and unloaded, there is no gapbetween upper jaw (3114) and lower jaw (3116). In view of the teachingsherein, other ways to provide an end effector with a jaw having aplacement tip that has an arcuate side when viewed in cross section willbe apparent to those of ordinary skill in the art.

7. Exemplary Stair Step or Toothed Tip Shape

As described above, a placement tip of an end effector can be configuredwith various shapes, including with various width profiles. One suchplacement tip is shown in FIG. 24B with placement tip (2319), which hasa stair step or toothed shaped. As shown in the top view of FIG. 24B,placement tip (2319) comprises distal sides (2329) leading to distal end(2330) where distal sides (2329) define a width profile that is stepped.In the present example, placement tip (2319) extends distally from ananvil of the end effector. However, placement tip (2319) is configurablesuch that it may be part of an anvil or part of a staple cartridge.Furthermore, placement tip (2319) is configurable such that it may bepositioned on either an upper jaw or lower jaw of the end effector. Inview of the teachings herein, it will be apparent to those of ordinaryskill in the art that this stepped width profile of placement tip (2319)can be used with any of the placement tips of the end effectorsdescribed herein.

As shown in the illustrated version, sides (2329) of placement tip(2319) define multiple regions (2331, 2333, 2335) of placement tip(2319), and each of regions (2331, 2333, 2335) comprise a differentwidth (W1, W2, W3) as shown. Moreover, with the stepped configuration,each width (W1, W2, W3) generally remains the same within its associatedregion (2331, 2333, 2335). Furthermore, when moving from a proximal endof placement tip (2319) to a distal end (2330) of placement tip (2319),the width (W1, W2, W3) of each region (2331, 2333, 2335) is less than orsmaller than the width of the immediate proximally located region.

In the present example shown in FIG. 24B, placement tip (2319) comprisesthree distinct regions (2331, 2333, 2335). In other versions, placementtip (2319) can be configured to have greater or fewer regions, whichwill be apparent to those of ordinary skill in the art in view of theteachings herein. As shown in FIG. 24B, sides (2329) further comprisesangled portions (2337) where one region transitions to an adjacentregion. In some other versions, angled portions (2337) can be orthogonalrelative to the adjacent portions of sides (2329) instead of angled. Inview of the teachings herein, other ways to configure placement tip(2319) and sides (2329) to define multiple regions having differentwidths will be apparent to those of ordinary skill in the art.

8. Exemplary Non-Rectangular Cross Section

One of the other variety of ways various placement tips for endeffectors can be configured pertains to the lateral cross-sectionalprofiles of the placement tips. As discussed above, surgical instruments(10, 310) described herein include an end effector at a distal end of anelongated shaft (22, 322). The end effectors include upper and lowerjaws where one of the jaws includes an anvil. In at least some versions,a placement tip extends from a distal end of the anvil.

FIG. 28 depicts an exemplary jaw (3514) useable with one or more of theend effectors described herein. In the illustrated example, jaw (3514)comprises an anvil (3518) and a placement tip (3519) extending from adistal end of anvil (3518). Placement tip (3519) is configured with abend (3520) distal to the location where placement tip (3519) attacheswith anvil (3518) and proximal to a distal end (3530) of placement tip(3519).

Referring to FIG. 29, placement tip (3519), in the illustrated version,tapers as placement tip (3519) extends distally. Various configurationsfor distal end (3530) of placement tip (3519) can be used as describedabove. Anvil (3518) defines a longitudinal axis and placement tip (3519)defines lateral cross sections that can be taken along its length atvarious positions. In the illustrated example of FIG. 29, a firstlateral cross section coincides with a position that is just proximal tobend (3520) and is indicated in FIG. 29 by line A-A. A second lateralcross section coincides with a position that is distal to bend (3520)and proximal to distal end (3530) and is indicated in FIG. 29 by lineB-B. In view of the teachings herein, other positions for lateral crosssections of placement tip (3519) will be apparent to those of ordinaryskill in the art.

FIGS. 30A-34B illustrate various cross-sectional profiles of placementtip (3519) or similar placement tips. Furthermore, many of thecross-sectional profiles illustrated represent non-rectangularcross-sectional profiles. For instance, FIGS. 30A and 30B illustrateexemplary inverted U-shape cross sectional profiles. FIG. 30A coincideswith a location on placement tip (3519) along line A-A as shown in FIG.29, while FIG. 30B coincides with a location on placement tip (3519)along line B-B. In this regard, the shapes of the cross-sectionalprofiles match, both being inverted U-shapes. However, the taper ofplacement tip (3519) provides for a smaller width or lateral dimensionalong the more distal position of placement tip (3519) compared to themore proximal position of placement tip (3519). Additionally, theinverted U-shape cross sectional profile in this version is defined byan underside surface (3522) having five connected orthogonally orientedsurfaces. In this manner, the U-shape cross sectional profile defines avoid or space with a rectangular shape.

FIGS. 31A and 31B illustrate various cross-sectional profiles of anotherplacement tip (3619) that is the same as placement tip (3519) shown inFIGS. 28 and 29. Accordingly, the description of placement tip (3519)with respect to FIGS. 28 and 29 applies equally to placement tip (3619).FIGS. 31A and 31B illustrate exemplary inverted U-shape cross sectionalprofiles, where the U-shapes are defined by a curved underside surface(3622). FIG. 31A coincides with a location on placement tip (3619) alongline A-A as shown in FIG. 29, while FIG. 31B coincides with a locationon placement tip (3619) along line B-B. In this regard, the shapes ofthe cross-sectional profiles match, both being inverted U-shapes.However, the taper of placement tip (3619) provides for a smaller widthor lateral dimension along the more distal position of placement tip(3619) compared to the more proximal position of placement tip (3619).Additionally, the inverted U-shape cross sectional profile in thisversion is defined by an underside surface (3622) having a curvedsurface as mentioned. In this manner, the U-shape cross sectionalprofile defines a void or space with a half-circle shape.

FIGS. 32A and 32B illustrate various cross-sectional profiles of anotherplacement tip (3719) that is the same as placement tip (3519) shown inFIGS. 28 and 29, except for the region proximal to bend (3520). Withplacement tip (3719), as will be shown by the cross sections, the regionproximal to the bend includes raised sides (3702) such that thecross-sectional profile is not flat or straight across the top surfaceas will be shown and described relative to FIG. 32A. Besides thisdifference between placement tip (3519) and placement tip (3719), thedescription of placement tip (3519) with respect to FIGS. 28 and 29applies equally to placement tip (3719). FIG. 32A illustrates anexemplary H-shape cross sectional profile, while FIG. 32B illustrates anexemplary U-shape cross sectional profile. FIG. 32A coincides with alocation on placement tip (3719) along line A-A as shown in FIG. 29,while FIG. 32B coincides with a location on placement tip (3719) alongline B-B. In this regard, the shapes of the cross-sectional profiles aredifferent unlike the examples discussed above. Also, the taper ofplacement tip (3719) provides for a smaller width or lateral dimensionalong the more distal position of placement tip (3719) compared to themore proximal position of placement tip (3719). Additionally, theinverted U-shape the bottom part of the H-shape cross sectional profilesin this version are defined by an underside surface (3722) having fiveconnected orthogonally oriented surfaces. In this manner, these portionsof the cross-sectional profiles define a void or space with arectangular shape.

FIGS. 33A and 33B illustrate various cross-sectional profiles of anotherplacement tip (3819) that is the same as placement tip (3519) shown inFIGS. 28 and 29. Accordingly, the description of placement tip (3519)with respect to FIGS. 28 and 29 applies equally to placement tip (3819).FIGS. 33A illustrates an exemplary inverted V-shape cross sectionalprofile, while FIG. 33B illustrates an exemplary rectangular shapeprofile. FIG. 33A coincides with a location on placement tip (3819)along line A-A as shown in FIG. 29, while FIG. 33B coincides with alocation on placement tip (3819) along line B-B. In this regard, theshapes of the cross-sectional profiles are different. Also, the taper ofplacement tip (3819) provides for a smaller width or lateral dimensionalong the more distal position of placement tip (3819) compared to themore proximal position of placement tip (3819). Additionally, at themore proximal region of placement tip (3819), the inverted V-shape crosssectional profile is defined by an underside surface (3822) having twoconnected angled surfaces. At the more distal region of placement tip(3819), the rectangular shape cross sectional profile is defined byunderside surface (3822) that is flat or straight. In this manner, theV-shape cross sectional profile defines a void or space with a triangleshape, whereas the rectangular shape cross sectional profile does notdefine any such void or space.

FIGS. 34A and 34B illustrate various cross-sectional profiles of anotherplacement tip (3919) that is the same as placement tip (3519) shown inFIGS. 28 and 29, except for the sides of placement tip (3919) arerounded. This impacts the cross-sectional profiles as will be shown anddescribed. Besides this difference between placement tip (3519) andplacement tip (3919), the description of placement tip (3519) withrespect to FIGS. 28 and 29 applies equally to placement tip (3919).FIGS. 34A and 34B illustrate exemplary oval cross-sectional profiles.FIG. 34A coincides with a location on placement tip (3919) along lineA-A as shown in FIG. 29, while FIG. 34B coincides with a location onplacement tip (3919) along line B-B. In this regard, the shapes of thecross-sectional profiles are of the same broad category, i.e. both oval,but the shapes differ in that the appearance of the oval shapes at eachprofile is not the same. The taper of placement tip (3919) provides fora smaller width, diameter, or lateral dimension along the more distalposition of placement tip (3919) compared to the more proximal positionof placement tip (3919). Additionally, the oval cross-sectional profilesin this version are defined by an underside surface (3922) having acurved surface as mentioned. In this manner, the oval cross-sectionalprofile does not define a void or space because the curvature of theunderside surface (3922) is convex unlike the curvature of undersidesurface (3622) shown in FIGS. 31A-31B. With respect to FIG. 34B, in someother versions, the shape of the cross-sectional profile along line B-Bof FIG. 29 is circular instead of oval. In view of the teachings herein,various modifications to the oval and circular configurations of thecross-sectional profiles of placement tip (3919) will be apparent tothose of ordinary skill in the art.

In the present examples, placement tips (3519, 3619, 3719, 3819, 3919)are configured as elastically deformable or deflectable. As discussedabove, this allows placement tips (3519, 3619, 3719, 3819, 3919) todeflect when subject to a force such as a clamping force. The variouslateral cross-sectional profiles shown and described above can be usedto manipulate or control the nature and degree of deflection thatplacement tips (3519, 3619, 3719, 3819, 3919) may undergo when subjectto a clamping force. Still in other versions, placement tips (3519,3619, 3719, 3819, 3919) are not required to be configured as elasticallydeformable or deflectable. In view of the teachings herein, various waysto configure and modify a placement tip for an end effector as describedherein, including ways to modify construction and lateralcross-sectional profiles, will be apparent to those of ordinary skill inthe art.

9. Exemplary Durometer Ranges and Visual Contrast

FIG. 35 depicts another exemplary jaw (4014) useable with one or more ofthe end effectors described herein. In the illustrated example, jaw(4014) comprises an anvil (4018) and a placement tip (4019) extendingfrom a distal end of anvil (4018). Placement tip (4019) is configuredwith a curved or bent configuration in the illustrated version. However,this curved or bent configuration is not required in all cases, and inother versions, placement tip (4019) can have a straight configuration.Returning to the illustrated version, placement tip (4019) is furtherconfigured as elastically deformable or deflectable. This allowsplacement tip (4019) to deflect when subject to a force such as aclamping force.

Placement tip (4019) is constructed from a material having a particulardurometer range. For instance, in the present example, placement tip(4019) is constructed from a material having a durometer between aboutShore 40A and about Shore 40D. However, this range should not beconsidered limiting or required in all versions, and in view of theteachings herein other suitable durometer ranges will be apparent tothose of ordinary skill in the art.

Additionally, placement tip (4019) is constructed from a material havinga high contrast color. By having a high contrast color compared to othermaterials of the surgical instrument, and compared to the environmentwhere the surgical instruments are being used, placement tip (4019) canprovided enhanced visualization for placement during use. In the presentexample, placement tip (4019) is constructed of a material having a neongreen color. In some instances, this color may be described asiridescent green or fluorescent green or highlighter green. In thepresent example, placement tip (4019) is further configured with slot(4021), which can provide a further color contrast relative to thematerial of placement tip (4019). Slot (4021) is not required in allversions, however. And further, in some versions, slot (4021) is omittedentirely or replaced as a region or area having another contrastingcolor to the remainder of placement tip (4019). In view of the teachingsherein, other high contrast colors and/or patterns of colors for usewith placement tip (4019) will be apparent to those of ordinary skill inthe art.

10. Exemplary Deflectable Straight Tip Extending Beyond Cartridge

While many of the elastically deformable placement tips shown anddescribed above are curved or bent, in other versions an end effectormay incorporate a placement tip that extends distally from one of thejaws in a straight manner. FIGS. 36-39 illustrate views of exemplary endeffectors (4112, 4212) that each comprises an elastically deformable ordeflectable straight placement tip (4119, 4219). Beginning with FIG. 36,end effector (4112) comprises an upper jaw (4114) and a lower jaw(4116). One or both of jaws (4114, 4116) are operable to move relativeto the other so as to open and close end effector (4112). End effector(4112) further comprises an anvil (4118) and a cartridge (4137), whichis the same or similar to cartridge (37) described above. Cartridge(4137) includes staples that are configured to strike or contact anvil(4118) in use as described and shown above with respect to instruments(10, 310). In the present example, upper jaw (4114) comprises anvil(4118), while lower jaw (4116) comprises cartridge (4137). Furthermore,in the present example, placement tip (4119) extends distally from anvil(4118) and does not angle toward lower jaw (4116) with cartridge (4137);but instead remains flat. Additionally, placement tip (4119) extendsdistally beyond cartridge (4137) of lower jaw (4116).

FIG. 37 illustrates end effector (4212), which comprises an upper jaw(4214) and a lower jaw (4216). One or both of jaws (4214, 4216) areoperable to move relative to the other so as to open and close endeffector (4212). End effector (4212) further comprises an anvil (4218)and a cartridge (4237), which is the same or similar to cartridge (37)described above. Cartridge (4237) includes staples that are configuredto strike or contact anvil (4218) in use as described and shown abovewith respect to instruments (10, 310). In the present example, upper jaw(4214) comprises anvil (4218), while lower jaw (4216) comprisescartridge (4237). Furthermore, in the present example, placement tip(4219) extends distally from anvil (4218) and does not angle towardlower jaw (4216) with cartridge (4237); but instead angles away fromlower jaw (4216) with cartridge (4237). In this manner, placement tip(4219) comprises upward angled surface (4222) near its distal end.Additionally, placement tip (4219) extends distally beyond cartridge(4237) of lower jaw (4216).

FIGS. 38 and 39 illustrate top views of the upper jaws (4114,4214) ofend effectors (4112, 4212). It should be understood that the top view ofFIG. 38 applies to both upper jaws (4114, 4214) of end effectors (4112,4212) in slightly different versions. Similarly, the top view of FIG. 39applies to both upper jaws (4114, 4214) of end effectors (4112, 4212) inslightly different versions.

With end effector (4112) of FIG. 36, in one version upper jaw (4114)with anvil (4118) and placement tip (4119) has placement tip (4119) thatis flat and rounded at its distal end as shown in FIG. 38. Additionally,as shown in FIG. 38, placement tip (4119) comprises the same width asanvil (4118). In another version of end effector (4112), upper jaw(4114) with anvil (4118) and placement tip (4119) has placement tip(4119) that is tapered with more of a pointed, yet slightly rounded,distal end as shown in FIG. 39. Additionally, as shown in FIG. 39, whileplacement tip (4119) tapers as it extends distally, at its proximalattachment point with anvil (4118) it has the same width as anvil(4118).

With end effector (4212) of FIG. 37, in one version upper jaw (4214)with anvil (4218) and placement tip (4219) has placement tip (4219) thatis flat and rounded its distal end as shown in FIG. 38. Additionally, asshown in FIG. 38, placement tip (4219) comprises the same width as anvil(4218). In another version of end effector (4212), upper jaw (4214) withanvil (4218) and placement tip (4219) has placement tip (4219) that istapered with more of a pointed, yet slightly rounded, distal end asshown in FIG. 39. Additionally, as shown in FIG. 39, while placement tip(4219) tapers as it extends distally, at its proximal attachmentlocation with anvil (4218) it has the same width as anvil (4218).

Regarding end effectors (4112, 4212), upper jaws (4114, 4214) withanvils (4118, 4218) and placement tips (4119, 4219) have been describedabove as being straight relative to a longitudinal axis of respectiveanvils (4118, 4218), yet deflectable when subject to a force such as aclamping force. Furthermore, placement tips (4119, 4219) have beendescribed as having various configurations that include flat androunded, angled away and rounded, flat and tapered, and angled away andtapered. In view of the teachings herein, various modifications to adeflectable and straight placement tip of an end effector that extendsbeyond a cartridge will be apparent to those of ordinary skill in theart. By way of example only, and not limitation, some such modificationsmay be directed to the shape of the distal end or other regions of theplacement tip, including cross sectional profiles both laterally andlongitudinally.

V. Surgical Stapling End Effector Jaw with Tip Deflecting Toward OtherJaw

A. End Effectors with Elastically Deformable Cartridge Tips

In some instances when a straight and rigid anvil is desired, anotherapproach to modify an end effector for enhanced visualization,maneuverability, and tissue gathering with an atraumatic tip includesthe addition of an elastomeric curved tip to the distal end of acartridge. In this manner, when end effector is closed and maneuveringto a procedure site, the added elastomeric curved tip on the distal endof cartridge fills the space that would otherwise exist at the distalend of the end effector. This configuration can reduce the drag at thedistal end when maneuvering the end effector by helping to deflecttissue away from the distal end of end effector when moving the endeffector through and along tissue.

FIGS. 40-42 show another exemplary end effector (11212) or componentsthereof incorporating an elastomeric curved tip (11214) attached to adistal end of a cartridge (11237). In addition to curved tip (11214) andcartridge (11237), end effector (11212) further comprises lower jaw(10016) and anvil (11218). Lower jaw (10016) is configured to receivecartridge (11237) in the same or similar manner as lower jaw (16)receives cartridge (37) as described above. Anvil (11218) is similar toanvil (18) described above, but with a more pointed distal end but beingstraight instead of curved. Cartridge (11237) is similar to cartridge(37) as described above with a difference being the incorporation ofelastomeric curved tip (11214). As shown in FIG. 40, cartridge (11237)further comprises tissue gripping features (11216) located on an upperdeck (11272) of cartridge (11237). Such tissue gripping features (11216)are optional features and they may be omitted in other versions.

As mentioned above, elastomeric curved tip (11214) is attached with theangled distal end of cartridge (11237). The connection of curved tip(11214) to cartridge (11237) may be achieved using a chemical ormechanical fastening. In view of the teachings herein those of ordinaryskill in the art will appreciate the various ways to connect curved tip(11214) with distal end of cartridge (11237). In some versions, curvedtip (11214) is bonded to cartridge (11237) using a molding process. Insuch examples, distal end of cartridge (11237) may comprise variousstructural features configured to engage with elastomeric material ofcurved tip (11214) during molding to thereby secure curved tip (11214)to distal end of cartridge (11237). In the present example, curved tip(11214) is resiliently biased to extend substantially perpendicularlyfrom the angled distal face of cartridge (11237), though it should beunderstood that curved tip (11214) may have any other suitable angularrelationship with the angled distal face of cartridge (11237). Inaddition, curved tip (11214) is resiliently biased to extend along aplane that is oriented obliquely relative to the longitudinal axis ofend effector (11212) in the present example.

Curved tip (11214) comprises lower lip (11220), upper lip (11222), anddividers (11224). Lower lip (11220) attaches with the angled distal endof cartridge (11237) as described above. Upper lip (11222) extends fromand connects with a proximal portion of lower lip (11220). Dividers(11224) extend vertically from lower lip (11220) and connect lower lip(11220) and upper lip (11222). In the present example, upper lip (11222)comprises top surface (11226) that includes gripping features (11228)configured to improve gripping tissue clamped between anvil (11218) andcartridge (11237), for example as shown in FIG. 42.

Referring to FIGS. 41 and 42, end effector (11212) is shown in theclosed position both when not clamping tissue and when clamping tissue.As shown, in the closed position in either scenario, the distal end ofanvil (11218) aligns with the longitudinal position of the distal end ofcartridge (11237). In other versions, end effector (11212) may beconfigured such that the distal end of anvil (11218) extends pastcartridge (11237) when end effector (11212) is closed. Still in otherversions, end effector (11212) may be configured such that the distalend of anvil (11218) terminates proximal to the distal end of cartridge(11237) when end effector (11212) is closed.

As shown in FIG. 42, when tissue (10090) is captured between anvil(11218) and cartridge (11237), elastomeric curved tip (11214) deformsfrom its open state in FIG. 41 to a closed state as shown in FIG. 42. Inthis deformed state, upper lip (11222) deflects downwardly toward lowerlip (11220). Furthermore, dividers (11224) are compressed and deflectlaterally. As shown in FIG. 42, in its deformed state, upper lip (11222)of curved tip (11214) extends distally of anvil (11218) and cartridge(11237). With tissue clamped between end effector (11212) a cutting andstapling sequence can now occur with end effector (11212) in a similarmanner to that described above with respect to end effector (12). Whenthe clamping force is released, curved tip (11214) may resilientlyreturn to the configuration and orientation shown in FIGS. 40-41.

In view of the teachings herein, it will be appreciated that endeffector (11212) may be used in place of any of the other end effectorsdescribed herein. For instance, end effector (11212) may be used inplace of end effector (12) shown in FIG. 1, or in place of end effector(312) shown in FIG. 11. In some versions, end effector (11212) may beintegrally formed with either shaft (22, 322) or alternatively may beseparately formed and then combined. In some versions, end effector(11212) may be provided for use in robotic systems as described above.

B. End Effectors with Elastically Deformable Tips on Thicker Jaw

In some instances when a straight and rigid jaw is desired, anotherapproach to modify an end effector for enhanced visualization,maneuverability, and tissue gathering includes the addition of aplacement tip on the distal end of the opposing jaw. In this manner,when end effector is closed and maneuvering to a procedure site, theplacement tip fills at least some of the space that would otherwiseexist at the distal end of the end effector. This configuration canreduce the drag at the distal end when maneuvering the end effector byhelping to deflect tissue away from the distal end of end effector whenmoving the end effector through and along tissue. In some cases as willbe described, the placement tip is made of an elastically deformablematerial such that the placement tip is responsive or deflects whensubject to force associated with clamping tissue between the jaws.

FIG. 43 shows an enlarged view of end effector (11312), which isconfigured for use with instruments (10, 310) and/or for robotic use asdescribed above. End effector (11312) comprises jaw (11314) and jaw(11316) that are configured in an opposing manner. Furthermore, jaws(11314, 11316) are operably configured such that one or both of the jaws(11314, 11316) are movable relative to the other to change the state ofend effector (11312) from an open position or state to a closed positionor state. For instance, this opening and closing of end effector (11312)provides for the ability to grasp, clamp, or release tissue. In thepresent example, FIG. 43 shows jaw (11314) as an upper jaw and jaw(11316) as a lower jaw. As mentioned above, the terms “upper” and“lower” are used as relative spatial references to help clarify thedescription of end effector (11312) and should not be interpreted in alimiting manner.

In the present example, a distal tip or placement tip (11319) extendsdistally from jaw (11316). Jaw (11316), excluding placement tip (11319),defines a longitudinal axis (LA11) that generally extends along thelength of jaw (11316) from the proximal end to the distal end. Placementtip (11319) defines another longitudinal axis (LA12). In the presentexample, axis (LA12) defined by placement tip (11319) extends in anon-parallel manner with respect to longitudinal axis (LA11) defined byjaw (11316) from which placement tip (11319) extends. With thisconfiguration, placement tip (11319) extends from jaw (11316) towardopposing jaw (11314). In other words, longitudinal axis (LA12) extendsaway from longitudinal axis (LA11) toward jaw (11314).

As shown in FIG. 43, jaw (11316) comprises a thickness (T11), while jaw(11314) comprises a thickness (T12). In the illustrated examples, jaw(11316) has a greater thickness than jaw (11314). Furthermore, placementtip (11319) connects with and extends from thicker jaw (11316) in thepresent example. As mentioned above in the present example placement tip(11316) extends from thicker jaw (11316) toward opposing thinner jaw(11314). As also shown in the illustrated version of FIG. 43, but notrequired in all versions, placement tip (11319) comprises about the samethickness as jaw (11316) to which it connects, at its thickest point.Furthermore, placement tip (11319) bends or curves toward jaw (11314)such that placement tip (11319) comprises a taper. In the presentexample placement tip (11319) tapers longitudinally. In some versions,placement tip (11319) tapers laterally. Still in some other versions,placement tip (11319) tapers both longitudinally and laterally. In viewof the teachings herein, other configurations for the taper of placementtip (11319), or lack thereof, will be apparent to those of ordinaryskill in the art.

In some versions of end effector (11312), placement tip (11319) isconstructed of an elastically deformable material. In this mannerplacement tip (11319) is biased to an initial orientation or positionwhen not subjected to force, and placement tip (11319) deflects toanother orientation or position when subject to force, i.e. the forceexerted on placement tip (11319) when clamping tissue. When the force isremoved, placement tip (11319) is resilient and thus returns to itsinitial orientation or position. Additionally, in the present example,placement tip (11319) is constructed of a resilient material asmentioned, where that material and placement tip (11319) has a lowerstiffness than jaw (11316) to which placement tip (11319) connects. Inother words, the material of placement tip (11319) has a lower stiffnessthan the material of jaw (11316) from which placement tip (11319)extends. In some instances, placement tip (11319) tapers such thatplacement tip (11319) comprises a distal end (11320) that is pointed. Insuch instances, where placement tip (11319) is comprised of anelastomeric and deflectable material, placement tip (11319) is stillconfigured as an atraumatic tip despite its pointed shape.

As described further above, end effector (11312) like end effectors(11212, 212), is configured such that one of jaws (11314, 11316)comprise anvil (10018), while the other of jaws (11314, 11316) comprisecartridge (10037). Although not required in all versions, in the presentexample jaw (11316) is configured to selectively retain cartridge(10037) or a similar cartridge, and jaw (11314) comprises anvil (10018)or a similar anvil. With this configuration, the thicker jaw (11316)comprises cartridge (10037) as well as placement tip (11319). In someother versions, the thicker jaw with placement tip (11319) may beconfigured as anvil (10018), while the thinner jaw may be configured toselectively retain the cartridge (10037). Thus, it is not required inall versions that the thicker jaw necessarily is the jaw that alsoselectively retains the cartridge. Furthermore, while the presentexample illustrates jaw (11316), to which placement tip (11319)connects, as a lower jaw relative to jaw (11314), in other versions thethicker jaw having placement tip (11319) is an upper jaw that may or maynot also include cartridge (10037) as mentioned above. In view of theteachings herein, other ways to configure end effector (11312) withplacement tip (11319) on the thicker jaw will be apparent to those ofordinary skill in the art.

FIGS. 44-46 illustrate other enlarged views of exemplary end effectorssuitable for use with instruments (10, 310) and/or for robotic use asdescribed above. Other than the placement tips, the other components ofthe end effectors of FIGS. 44-46 are the same as those of end effector(11312) of FIG. 43. Therefore, the discussion that follows focuses onthe placement tips rather than repeating the description of thosefeatures that are the same as with end effector (11312) and alreadydescribed above.

FIG. 44 shows an enlarged view of an end effector (11412). End effector(11412) is the same as end effector (11312) with the exception thatplacement tip (11319) is replaced with placement tip (11419). Placementtip (11419) extends from jaw (11316), which is the thicker jaw comparedto jaw (11314) as described above. In the version shown in FIG. 44,placement tip (11419) curves or bends away from jaw (11316) andlongitudinal axis (LA11) and toward jaw (11314). In the present example,placement tip (11419) comprises an end (11420) that touches or contactsthe distal-most end of jaw (11314) when end effector is in a closed anunloaded state where tissue is not between jaws (11314, 11316). Withthis configuration, placement tip (1419) fills the gap or space betweenjaws (11314, 11316) when end effector (11412) is closed. Such aconfiguration can improve maneuverability when moving end effector(11412) through tissue to a desired site.

As also shown in the illustrated version of FIG. 44, but not required inall versions, placement tip (11419) comprises about the same thicknessas jaw (11316) to which it connects, at its thickest point. Furthermore,placement tip (11419) comprises a taper such that placement tip (11419)tapers as it extends away from jaw (11316) and toward jaw (11314). Inthe present example placement tip (11419) tapers longitudinally. In someversions, placement tip (11419) tapers laterally. Still in some otherversions, placement tip (11419) tapers both longitudinally andlaterally. In view of the teachings herein, other configurations for thetaper of placement tip (11419), or lack thereof, will be apparent tothose of ordinary skill in the art.

In the present example, but not required in all examples, placement tip(11419) is constructed of an elastically deformable material. In thismanner placement tip (11419) is biased to an initial orientation orposition when not subjected to force, and placement tip (11419) deflectsto another orientation or position when subject to force, i.e. the forceexerted on placement tip (11419) when clamping tissue. When the force isremoved, placement tip (11419) is resilient and thus returns to itsinitial orientation or position. Additionally, in the present example,placement tip (11419) is constructed of a resilient material asmentioned, where that material and placement tip (11419) has a lowerstiffness than jaw (11316) to which placement tip (11419) connects. Inother words, the material of placement tip (11419) has a lower stiffnessthan the material of jaw (11316) from which placement tip (11419)extends. In some instances, placement tip (11419) tapers such thatplacement tip (11419) comprises a distal end (11420) that is pointed. Insuch instances, where placement tip (11419) is comprised of anelastomeric and deflectable material, placement tip (11419) is stillconfigured as an atraumatic tip despite its pointed shape.

End effector (11412), like end effector (11312) and others describedabove, is configured such that one of jaws (11314, 11316) comprise anvil(10018), while the other of jaws (11314, 11316) comprise cartridge(10037). Although not required in all versions, in the present examplejaw (11316) is configured to selectively retain cartridge (10037) or asimilar cartridge, and jaw (11314) comprises anvil (10018) or a similaranvil. With this configuration, the thicker jaw (11316) comprisescartridge (10037) as well as placement tip (11419). In some otherversions, the thicker jaw with placement tip (11419) may be configuredas anvil (10018), while the thinner jaw may be configured to selectivelyretain the cartridge (10037). Thus, it is not required in all versionsthat the thicker jaw necessarily is the jaw that also selectivelyretains the cartridge. Furthermore, while the present exampleillustrates jaw (11316), to which placement tip (11419) connects, as alower jaw relative to jaw (11314), in other versions the thicker jawhaving placement tip (11419) is an upper jaw that may or may not alsoinclude cartridge (10037) as mentioned above. In view of the teachingsherein, other ways to configure end effector (11412) with placement tip(11419) on the thicker jaw will be apparent to those of ordinary skillin the art.

FIG. 45 shows an enlarged view of an end effector (11512). End effector(11512) is the same as end effector (11312) with the exception thatplacement tip (11319) is replaced with placement tip (11519). Placementtip (11519) extends from jaw (11316), which is the thicker jaw comparedto jaw (11314) as described above. In the version shown in FIG. 45,placement tip (11519) comprises a straight geometry where placement tip(11519) extends distally from jaw (11316) in a straight fashion withoutbending or curving toward opposing jaw (11314). This configurationprovides a large gap or space between jaws (11314, 11316) when endeffector (11512) is in a closed and unloaded state as shown in FIG. 45.Such a configuration can improve tissue capture and visibility whenclamping, cutting, and stapling tissue.

As also shown in the illustrated version of FIG. 45, but not required inall versions, placement tip (11519) is less thick compared to thickness(T11) of jaw (11316) to which placement tip (11519) connects.Furthermore, placement tip (11519) comprises a taper such that placementtip (11519) tapers as it extends away from jaw (11316). In the presentexample placement tip (11519) tapers longitudinally. In some versions,placement tip (11519) tapers laterally. Still in some other versions,placement tip (11519) tapers both longitudinally and laterally. In viewof the teachings herein, other configurations for the taper of placementtip (11519), or lack thereof, will be apparent to those of ordinaryskill in the art.

In the present example, but not required in all examples, placement tip(11519) is constructed of an elastically deformable material. In thismanner placement tip (11519) is biased to an initial orientation orposition when not subjected to force, and placement tip (11519) deflectsto another orientation or position when subject to force, i.e. the forceexerted on placement tip (11519) when clamping tissue. When the force isremoved, placement tip (11519) is resilient and thus returns to itsinitial orientation or position. Additionally, in the present example,placement tip (11519) is constructed of a resilient material asmentioned, where that material and placement tip (11519) has a lowerstiffness than jaw (11316) to which placement tip (11519) connects. Inother words, the material of placement tip (11519) has a lower stiffnessthan the material of jaw (11316) from which placement tip (11519)extends. In some instances, placement tip (11519) tapers such thatplacement tip (11519) comprises a distal end (11520) that is pointed. Insuch instances, where placement tip (11519) is comprised of anelastomeric and deflectable material, placement tip (11519) is stillconfigured as an atraumatic tip despite its pointed shape.

End effector (11512), like end effector (11312) and others describedabove, is configured such that one of jaws (11314, 11316) comprise anvil(10018), while the other of jaws (11314, 11316) comprise cartridge(10037). Although not required in all versions, in the present examplejaw (11316) is configured to selectively retain cartridge (10037) or asimilar cartridge, and jaw (11314) comprises anvil (10018) or a similaranvil. With this configuration, the thicker jaw (11316) comprisescartridge (10037) as well as placement tip (11519). In some otherversions, the thicker jaw with placement tip (11519) may be configuredas anvil (10018), while the thinner jaw may be configured to selectivelyretain the cartridge (10037). Thus, it is not required in all versionsthat the thicker jaw necessarily is the jaw that also selectivelyretains the cartridge. Furthermore, while the present exampleillustrates jaw (11316), to which placement tip (11519) connects, as alower jaw relative to jaw (11314), in other versions the thicker jawhaving placement tip (11519) is an upper jaw that may or may not alsoinclude cartridge (10037) as mentioned above. In view of the teachingsherein, other ways to configure end effector (11512) with placement tip(11519) on the thicker jaw will be apparent to those of ordinary skillin the art.

FIG. 46 shows an enlarged view of an end effector (11612). End effector(11612) is the same as end effector (11312) with the exception thatplacement tip (11319) is replaced with placement tip (11619). Placementtip (11619) extends from jaw (11316), which is the thicker jaw comparedto jaw (11314) as described above. In the version shown in FIG. 46,placement tip (11619) curves or bends away from jaw (11316) andlongitudinal axis (LA11) and toward jaw (11314). In the present example,placement tip (11619) comprises an end (11620) that does not touch orcontact the distal-most end of jaw (11314) when end effector is in aclosed an unloaded state where tissue is not between jaws (11314,11316). With this configuration, there remains a gap or space betweenjaws (11314, 11316) when end effector (11612) is closed and in anunloaded state as shown in FIG. 46. Such a configuration can improvetissue capture and visibility when clamping, cutting, and staplingtissue.

As also shown in the illustrated version of FIG. 46, but not required inall versions, placement tip (11619) is less thick compared to thickness(T11) of jaw (11316) to which placement tip (11619) connects.Furthermore, placement tip (11619) comprises a taper such that placementtip (11619) tapers as it extends away from jaw (11316). In the presentexample placement tip (11619) tapers longitudinally. In some versions,placement tip (11619) tapers laterally. Still in some other versions,placement tip (11619) tapers both longitudinally and laterally. In viewof the teachings herein, other configurations for the taper of placementtip (11619), or lack thereof, will be apparent to those of ordinaryskill in the art.

In the present example, but not required in all examples, placement tip(11619) is constructed of an elastically deformable material. In thismanner placement tip (11619) is biased to an initial orientation orposition when not subjected to force, and placement tip (11619) deflectsto another orientation or position when subject to force, i.e. the forceexerted on placement tip (11619) when clamping tissue. When the force isremoved, placement tip (11619) is resilient and thus returns to itsinitial orientation or position. Additionally, in the present example,placement tip (11619) is constructed of a resilient material asmentioned, where that material and placement tip (11619) has a lowerstiffness than jaw (11316) to which placement tip (11619) connects. Inother words, the material of placement tip (11619) has a lower stiffnessthan the material of jaw (11316) from which placement tip (11619)extends. In some instances, placement tip (11619) tapers such thatplacement tip (11619) comprises a distal end (11620) that is pointed. Insuch instances, where placement tip (11619) is comprised of anelastomeric and deflectable material, placement tip (11619) is stillconfigured as an atraumatic tip despite its pointed shape.

End effector (11612), like end effector (11312) and others describedabove, is configured such that one of jaws (11314, 11316) comprise anvil(10018), while the other of jaws (11314, 11316) comprise cartridge(10037). Although not required in all versions, in the present examplejaw (11316) is configured to selectively retain cartridge (10037) or asimilar cartridge, and jaw (11314) comprises anvil (10018) or a similaranvil. With this configuration, the thicker jaw (11316) comprisescartridge (10037) as well as placement tip (11619). In some otherversions, the thicker jaw with placement tip (11619) may be configuredas anvil (10018), while the thinner jaw may be configured to selectivelyretain the cartridge (10037). Thus, it is not required in all versionsthat the thicker jaw necessarily is the jaw that also selectivelyretains the cartridge. Furthermore, while the present exampleillustrates jaw (11316), to which placement tip (11619) connects, as alower jaw relative to jaw (11314), in other versions the thicker jawhaving placement tip (11619) is an upper jaw that may or may not alsoinclude cartridge (10037) as mentioned above. In view of the teachingsherein, other ways to configure end effector (11612) with placement tip(11619) on the thicker jaw will be apparent to those of ordinary skillin the art.

Referring again to FIG. 43, FIG. 43 illustrates reference markings thatdefine multiple zones that can be used to describe the location orplacement of the end of the placement tip of an exemplary end effector.For instance, a first reference plane (P11) is defined by a top surfaceof jaw (11316), and second reference plane (P12) is defined by a distalend of jaw (11316). Additionally, a third reference plane (P13) isdefined by a bottom surface of jaw (11316). Third reference plane (P13)in the present example is parallel with first reference plane (P11) andalso orthogonal to second reference plane (P12). With thisconfiguration, six zones are defined by the intersections of first andthird reference planes (P11, P13) with second reference plane (P12).

A first zone (Z11) is the region above the top surface of jaw (11316)(corresponding with first reference plane (P11)) and proximal to thedistal end of jaw (11316) (corresponding with second reference plane(P12)). A second zone (Z12) is shown as the region above the top surfaceof jaw (11316) (corresponding with first reference plane (P11)) anddistal to the distal end of jaw (11316) (corresponding with secondreference plane (P12)). A third zone (Z13) is shown as the region belowthe top surface of jaw (11316) (corresponding with first reference plane(P11)) yet above the bottom surface of jaw (11316) (corresponding withthird reference plane (P13)), and proximal to the distal end of jaw(11316) (corresponding with second reference plane (P12)). A fourth zone(Z14) is shown as the region below the top surface of jaw (11316)(corresponding with first reference plane (P11)) yet above the bottomsurface of jaw (11316) (corresponding with third reference plane (P13)),and distal to the distal end of jaw (11316) (corresponding with secondreference plane (P12)). A fifth zone (Z15) is shown as the region belowthe bottom surface of jaw (11316) (corresponding with third referenceplane (P13)), and proximal to the distal end of jaw (11316)(corresponding with second reference plane (P12)). A sixth zone (Z16) isshown as the region below the bottom surface of jaw (11316)(corresponding with third reference plane (P13)), and distal to thedistal end of jaw (11316) (corresponding with second reference plane(P12)).

Using this reference system, exemplary end effectors (11312, 11412,11512, 11612) can be described in a way that illustrates variouslocations or placements for the end of the various placement tips whenthe end effector is in a closed and unloaded state. Referring to FIG.43, the illustrated configuration shows placement tip (11319) extendsthrough third zone (Z13) and fourth zone (Z14), and the location of anend (11320) of placement tip (11319) is in second zone (Z12). In view ofthe teachings herein, it will be apparent to those of ordinary skill inthe art that when placement tip (11319) is deformable and end effector(11312) is in a closed and loaded state that the location of end (11320)of placement tip (11319) may deflect yet remain in second zone (Z12), orplacement tip (11319) may deflect such that end (11320) changes itslocation in the closed and loaded state to another one of the zones.

With respect to FIG. 44 and placement tip (11419), the illustratedconfiguration shows placement tip (11419) extends through third zone(Z13), fourth zone (Z14), second zone (Z12), and the location of an end(11420) of placement tip (1419) is in first zone (Z11). In view of theteachings herein, it will be apparent to those of ordinary skill in theart that when placement tip (11419) is deformable and end effector(11412) is in a closed and loaded state that the location of end (11420)of placement tip (11419) may deflect yet remain in first zone (Z11), orplacement tip (11419) may deflect such that end (11420) changes itslocation in the closed and loaded state to another one of the zones.

With respect to FIG. 45 and placement tip (11519), the illustratedconfiguration shows placement tip (11519) extends through third zone(Z13), and the location of an end (11520) of placement tip (11519) is infourth zone (Z14). In view of the teachings herein, it will be apparentto those of ordinary skill in the art that when placement tip (11519) isdeformable and end effector (15112) is in a closed and loaded state thatthe location of end (11520) of placement tip (11519) may deflect yetremain in fourth zone (Z14), or placement tip (11519) may deflect suchthat end (11520) changes its location in the closed and loaded state toanother one of the zones.

With respect to FIG. 46 and placement tip (11619), the illustratedconfiguration shows placement tip (11619) extends through third zone(Z13), fourth zone (Z14), and the location of an end (11620) ofplacement tip (11619) is in second zone (Z12). In view of the teachingsherein, it will be apparent to those of ordinary skill in the art thatwhen placement tip (11619) is deformable and end effector (11612) is ina closed and loaded state that the location of end (11620) of placementtip (11619) may deflect yet remain in second zone (Z12), or placementtip (11619) may deflect such that end (11620) changes its location inthe closed and loaded state to another one of the zones.

VI. Permanent Attachment Means for Curved Tip of Component of SurgicalStapling Instrument

A. Exemplary Attachment for End Effector Deflectable Tip

In some instance where a surgical instrument incorporates a deflectabletip the same or similar to those described above, the deflectable tipcan be a structure that is attached with the distal end of an endeffector of the surgical instrument. In some cases, this attachment maybe configured to create a permanent attachment between the deflectabletip and the end effector, but in other instances the attachment may beselective such that permanent attachment is not required. Regardless ofthe nature of the attachment, the deflectable tip is attached with theend effector such that it remains secured with the end effector duringuse of the instrument.

1. Mechanical Fastening

FIGS. 47-49 depicts views of an enlarged portion of a jaw (20418) of anend effector, which is configured for use with instruments (10, 310)and/or for robotic use as described above. Jaw (20418), is positionableopposite to another jaw, such as jaw (16) or jaw (216) as describedabove in forming the end effector. Jaw (20418) and/or the other opposingjaw of the end effector are operable to move relative to one anotherbetween an open position and a closed position. In this manner, the endeffector is operable to receive tissue between the jaws and subsequentlyrelease, clamp, cut, and/or staple the tissue. In view of the teachingsherein, it will be apparent to those of ordinary skill in the art thatjaw (20418) may be used with a variety of end effectors, at least someof which are described herein or incorporated by reference.

In the illustrated example, jaw (20418) comprises a base (20420), a cap(20422), a placement tip (20424), and a retention feature (20426).Placement tip (20424) is elastically deformable and extends distallyfrom the base (20420) when assembled. As shown in the illustratedversion, placement tip (20424) is bent or angled such that a proximalportion (20428) of placement tip (20424) and a distal portion (20430)define an angle that is less than 180 degrees. Still in other versions,placement tip (20424) is not required to be bent or angled, and insteadplacement tip (20424) is straight such that proximal portion (20428) anddistal portion (20430) are co-planar and define an angle that is 180degrees or thereabout. Still in other versions, placement tip (20424)may be curved, wherein as placement tip (20424) extends distally,placement tip (20424) curves toward the opposing jaw. In view of theteachings herein, other shapes and ways to configure placement tip(20424) will be apparent to those of ordinary skill in the art.

A connection member (20432) extends proximally from proximal portion(20428) of placement tip (20424). Connection member (20432) isconfigured with an opening (20434) as well as first lateral projectingwing (20436) and second lateral projecting wing (20438). In the presentexample, opening (20434) is located between first and second lateralprojecting wings (20436, 20438). Furthermore, opening (20434) isconfigured to receive retention feature (20426) when attaching placementtip (20424) with base (20420). When retention feature (20426) isinserted within opening (20434), first and second lateral projectingwings (20436, 20438) deflect laterally away from opening (20434). Thisdeflection of first and second lateral projecting wings (20436, 20438)increases the contact or engagement between placement tip (20424) andbase (20420), which aids in securing placement tip (20424) with base(20420).

As mentioned, retention feature (20426) is configured to secureplacement tip (20424) with jaw (20418), and in the present example withbase (20420) of jaw (20418). Retention feature (20426) is furtherconfigured to prevent removal of placement tip (20424) from jaw (20418).In the present example, retention feature (20426) comprises grippingfeatures (20440) in the form of ribs or threads that are configured tobite into or engage the surface of first and second lateral projectingwings (20436, 20438) that defines opening (20434). In this manner,retention feature (20426) securely attaches with connection member(20432), and as mentioned, imparts an outward force on first and secondlateral projecting wings (20436, 20438) causing wings (20436, 20438) todeflect outward and engage with base (20420). In view of the teachingsherein, other ways to modify or configure retention member (20426) toprovide for secure attachment with placement tip (20424) will beapparent to those of ordinary skill in the art.

As shown in FIG. 47, in the present version retention feature (20426)comprises a fastener, such as a tack or similar fastener, having a body(20442) and post (20444) extending from body (20442). Post (20444)includes gripping features (20440) described above. In the illustratedexample of FIGS. 47-49, jaw (20418) is configured such that retentionfeature (20426) connects or attaches placement tip (20424) with base(20420) by locating retention feature (20426) above placement tip(20424) and advancing retention feature (20426) downward such that post(20444) extends through opening (20434) of connection member (20432). Inthis manner, retention feature (20426) is insertable from the side ofbase (20420) that faces away from or is farthest from the opposing jawused with jaw (20418) in forming the end effector.

Base (20420) comprises central channel (20446) defined between and byinner elongated portions (20448). Base (20420) further comprises outerelongated portions (20450) that extend parallel to inner elongatedportions (20448). Although not required in all versions, elongatedportions (20448, 450) may be formed together as a unitary structure. Ata distal end of base (20420), a space (20452) is defined between innerelongated portions (20448 and outer elongated portions (20450). Space(20452) is configured with a complementary shape to connection member(20432), such that connection member (20432) is able to fit within space(20452). In this manner, space (20452) can also be considered a notch orcut-out configured to receive connection member (20432). Base (20420)further includes a bottom surface beneath space (20452) such thatconnection member (20432) cannot pass through space (20452). As shown,outer elongated portions (20450) each comprise distal flange (20454).Distal flanges (20454) are configured to abut or contact shoulderportions (20456) of connection member (20432) when connection member(20432) is within space (20452). In this manner, this interferencefitting prevents placement tip (20424) from distal separation from base(20420).

Jaw (20418) further comprises cap (20422) as mentioned above. Cap(20422) is configured to attach with base (20420) and with part ofproximal portion (20428) of placement tip (20426). Furthermore, cap(20422) installs from above placement tip (20424), retention feature(20426), and base (20420). In this manner, cap (20422) covers retentionfeature (20426) such that retention feature (20426) is concealed withinjaw (20418). Furthermore, in the present example, an underside surfaceof cap (20422) contacts body (20442) of retention feature (20426) tofurther secure retention feature (20426) in place. As will be describedbelow, cap (20422) is not required in all versions, nor is it requiredin all versions that retention feature (20426) is entirely concealedwithin jaw (20418). In the present example, cap (20422) is configured topermanently attach with base (20420) and the part of placement tip(20424) as shown. This permanent attachment of cap (20422) is achievedby welding cap (20422) in place, but can be permanently attached otherways like adhesives, mechanical fasteners, etc. In other versions, cap(20422) is configured to securely but selectively connect with or attachwith base (20420) and the part of placement tip (20424). In view of theteachings herein, other ways to configure cap (20422) to connect withother components of jaw (20418) to secure placement tip (20424) with jaw(20418) will be apparent to those of ordinary skill in the art in viewof the teachings herein.

FIGS. 43 and 44 depicts views of an enlarged portion of a jaw (20518) ofan end effector, which is configured for use with instruments (10, 310)and/or for robotic use as described above. Jaw (20518), is positionableopposite to another jaw, such as jaw (16) or jaw (216) as describedabove in forming the end effector. Jaw (20518) and/or the other opposingjaw of the end effector are operable to move relative to one anotherbetween an open position and a closed position. In this manner, the endeffector is operable to receive tissue between the jaws and subsequentlyrelease, clamp, cut, and/or staple the tissue. In view of the teachingsherein, it will be apparent to those of ordinary skill in the art thatjaw (20518) may be used with a variety of end effectors, at least someof which are described herein or incorporated by reference.

In the illustrated version, jaw (20518) comprises a base (20520), a cap(20522), a placement tip (20524), and a retention feature (20526).Placement tip (20524) is elastically deformable and extends distallyfrom the base (20520) when assembled. As shown in the illustratedversion, placement tip (20524) is bent or angled such that a proximalportion (20528) of placement tip (20524) and a distal portion (20530)define an angle that is less than 180 degrees. Still in other versions,placement tip (20524) is not required to be bent or angled, and insteadplacement tip (20524) is straight such that proximal portion (20528) anddistal portion (20530) are co-planar and define an angle that is 180degrees or thereabout. Still in other versions, placement tip (20524)may be curved, wherein as placement tip (20524) extends distally,placement tip (20524) curves toward the opposing jaw. In view of theteachings herein, other shapes and ways to configure placement tip(20524) will be apparent to those of ordinary skill in the art.

A connection member (20532) extends proximally from proximal portion(20528) of placement tip (20524). Connection member (20532) isconfigured with an opening (20534) as well as first lateral projectingwing (20536) and second lateral projecting wing (20538). In the presentexample, opening (20534) is located between first and second lateralprojecting wings (20536, 20538). Furthermore, opening (20534) isconfigured to receive retention feature (20526) when attaching placementtip (20524) with base (20520). When retention feature (20526) isinserted within opening (20534), first and second lateral projectingwings (20536, 538) deflect laterally away from opening (20534). Thisdeflection of first and second lateral projecting wings (20536, 20538)increases the contact or engagement between placement tip (20524) andbase (20520), which aids in securing placement tip (20524) with base(20520).

As mentioned, retention feature (20526) is configured to secureplacement tip (20524) with jaw (20518), and in the present example withbase (20520) of jaw (20518). Retention feature (20526) is furtherconfigured to prevent removal of placement tip (20524) from jaw (20518).In the present example, retention feature (20526) comprises grippingfeatures (20540) in the form of ribs or threads that are configured tobite into or engage the surface of first and second lateral projectingwings (20536, 20538) that defines opening (20534). In this manner,retention feature (20526) securely attaches with connection member(20532), and as mentioned, imparts an outward force on first and secondlateral projecting wings (20536, 20538) causing wings (20536, 20538) todeflect outward and engage with base (20520). In view of the teachingsherein, other ways to modify or configure retention member (20526) toprovide for secure attachment with placement tip (20524) will beapparent to those of ordinary skill in the art.

As best shown in FIG. 44, in the present version retention feature(20526) comprises a fastener, such as a tack or similar fastener, havinga body (20542) and post (20544) extending from body (20442). Post(20444) includes gripping features (20440) described above. Body (20442)comprises gripping features (20545), which are configured to assist ingripping tissue grasped between jaw (20518) and the opposing jaw of theend effector using jaw (20518). In the illustrated example of FIGS. 43and 44, jaw (20518) is configured such that retention feature (20526)connects or attaches placement tip (20524) with base (20520) by locatingretention feature (20526) below placement tip (20524) and advancingretention feature (20526) upward such that post (20544) extends throughopening (20534) of connection member (20532). In this manner, retentionfeature (20526) is insertable from the side of base (20520) facing orclosest to the opposing jaw used with jaw (20518) in forming the endeffector.

Base (20520) comprises central channel (20546) defined between and byinner elongated portions (20548). Base (20520) further comprises outerelongated portions (20550) that extend parallel to inner elongatedportions (20548). Although not required in all versions, elongatedportions (20548, 20550) may be formed together as a unitary structure.At a distal end of base (20520), a space (20552) is defined betweeninner elongated portions (20548 and outer elongated portions (20550).Space (20552) is configured with a complementary shape to connectionmember (20532), such that connection member (20532) is able to fitwithin space (20552). In this manner, space (20552) can also beconsidered a notch or cut-out configured to receive connection member(20532). Base (20520) further includes a top surface above space (20552)such that connection member (20532) cannot pass through space (20552).As shown, outer elongated portions (20550) join at the distal end ofbase (20520) and comprise distal flange (20554). Distal flange (20554)is configured to abut or contact shoulder portions (20556) of connectionmember (20532) when connection member (20532) is within space (20552).In this manner, this interference fitting prevents placement tip (20524)from distal separation from base (20520).

Jaw (20518) further comprises cap (20522) as mentioned above. Cap(20522) is configured to attach with base (20520), and in particularwith an upper surface of base (20520). As shown in FIG. 43, with jaw(20518) assembled, the only portion of retention feature (20526) that isexposed or revealed is the surface facing the opposing jaw that includesgripping features (20545). While FIG. 44 illustrates cap (20522) as partof jaw (20518), in some other versions, cap (20522) is omitted entirely.In the illustrated version of FIG. 44 where cap (20522) is present, cap(20522) is configured to permanently attach with base (20520). Thispermanent attachment of cap (20522) is achieved by welding cap (20522)in place, but can be permanently attached other ways like adhesives,mechanical fasteners, etc. Still, in other versions, cap (20522) isconfigured to securely but selectively connect with or attach with base(20520). In view of the teachings herein, other ways to configure cap(20522) to connect with other components of jaw (20518) to secureplacement tip (20524) with jaw (20518) will be apparent to those ofordinary skill in the art in view of the teachings herein.

In the above described versions of jaws (20418, 20518), each of jaw(20418, 20518) is configured as an anvil, where each base (20420, 20520)comprises a plurality of staple forming pockets on an underside surface.For instance, FIG. 44 illustrates staple forming pockets (20558). Withthis configuration, the opposing jaw to jaws (20418, 20518) comprise ajaw that is configured to retain a stapling cartridge. By way ofexample, and not limitation, as mentioned above, jaws (16, 216)described above may be used in conjunction with either of jaws (20418,20518) when configuring the end effector for use with surgicalinstruments (10, 310). In some other versions, jaws (20418, 20518) arenot required to comprise an anvil, and instead may be configured ormodified such that jaws (20418, 20518) may comprise a cartridge, withthe opposing jaw configured with an anvil. In view of the teachingsherein, other ways to configure jaws (20418, 20518) for use with an endeffector for a surgical instrument (10, 310) will be apparent to thoseof ordinary skill in the art.

2. Surface Treatment and Features with Overmolding

While the above section describes and illustrates ways of attaching adeflectable placement tip with a jaw of an end effector using aretention feature such as a fastener or tack, other ways to attach adeflectable placement tip with a jaw of an end effector includeovermolding the placement tip onto a part of the jaw of the endeffector. With the description of the jaws that follow, surfacetreatments and/or features are added to the jaws to provide for improvedovermolding attachment of the deformable or deflectable placement tip,and to prevent detachment and edge peeling.

FIG. 45 depicts a perspective view of a portion of an exemplary jaw(20618) of an end effector, which is configured for use with instruments(10, 310) and/or for robotic use as described above. Jaw (20618), ispositionable opposite to another jaw, such as jaw (16) or jaw (216) asdescribed above in forming the end effector. Jaw (20618) and/or theother opposing jaw of the end effector are operable to move relative toone another between an open position and a closed position. In thismanner, the end effector is operable to receive tissue between the jawsand subsequently release, clamp, cut, and/or staple the tissue. In viewof the teachings herein, it will be apparent to those of ordinary skillin the art that jaw (20618) may be used with a variety of end effectors,at least some of which are described herein or incorporated byreference.

Referring to FIGS. 45 and 46, jaw (20618) comprises a body (20620) and aplacement tip (20624). With respect to FIG. 46, placement tip (20624) isshown in phantom to reveal further features of body (20620) as will bedescribed further below. In the present example, body (20620) comprisesan anvil that includes staple forming pockets and a channel for acutting blade as described above. In other versions, body (20620) is notrequired to be configured as the anvil, and instead the anvil may be theopposite jaw to jaw (20620). In such other versions, body (20620) can beconfigured to retain a staple cartridge as described above.

Returning now to the present illustrated example, body or anvil (20620)comprises a distal portion (20626). Distal portion (20626) comprisesconnection features that are configured to improve the overmoldingattachment of placement tip (20624) with body (20620). One suchconnection feature comprises a protrusion (20628). Protrusion (20628)has a similar shape with the majority of body (20620) but is sizedslightly smaller. Protrusion (20628) extends distally from the remainderof body (20620) and defines a bonding surface (20630) that extendsaround the circumference of protrusion (20628) and that is orientedorthogonally to a bonding surface (20632) defined by body (20620).Protrusion (20628) further defines another bonding surface (20634),which is generally orthogonal to bonding surface (20630) and parallelwith bonding surface (20632).

Another connection feature of distal portion (20626) is protrusion(20636), which extends distally from protrusion (20628). Protrusion(20636) comprises a rectangular prism having a bore (20638) extendingtherethrough. Bore (20638) acts as a connection feature by providingspace where material of the overmolded placement tip (20624) can flowand bond to. Furthermore, protrusion (20636) also defines anotherconnection feature with a bonding surface (20640) on the four sides ofprotrusion. Bonding surface (20640) is oriented orthogonally to bondingsurface (20634) of protrusion (20628).

Another connection feature of distal portion (20626) is protrusion(20642), which is at the distal end of distal portion (20626).Protrusion (20642) is oriented orthogonally relative to protrusion(20636) from which it is attached. Protrusion (20642) further comprisesa plurality of notches (20644) that act as additional connectionfeatures by providing space where material of the overmolded placementtip (20624) can flow and bond to. In this manner, notches (20644)provide increased surface area for material bonding during theovermolding process. In the illustrated version, but not required in allversions, protrusion (20642) comprises six notches. Furthermore, each ofthe six notches are generally shaped the same, as square cut-outs. Insome other versions, greater or fewer notches, and/or notches havingother shapes or varying shapes can be used. In view of the teachingsherein, other ways to configure protrusion (20642) and notches (20644)will be apparent to those of ordinary skill in the art. In addition tothe bonding surfaces provided by notches (20644), protrusion (20642)further defines a bonding surface (20646) on proximal and distalsurfaces of protrusion (20642). Bonding surface (20646) is orientedorthogonally relative to bonding surface (20640) of protrusion (20636).

With the above described configuration of body (20620) and in particulardistal portion (20626), improved overmolding is achieved byincorporating a plurality of connection features. Moreover, theseconnection features can have the form of a series of protrusions (20628,20636, 20642) where each protrusion extends distally from the precedingprotrusion. Still yet, these protrusions (20628, 20636, 20642) areconfigured to present alternating orthogonally oriented bonding surfaces(20630, 20640, 20646). Another noteworthy connection feature of distalportion (20626) comprises the relative sizes of protrusions (20628, 636,642). In particular, the middle protrusion, protrusion (20636), has asmaller lateral dimension or width than the other protrusions (20628,20642). With this configuration, distal portion (20626) defines voids(20648) on each side of protrusion (20636) where material forovermolding placement tip (20624) can flow. While a variety ofconnection features have been shown and described above, other ways toconfigure or modify distal portion (20626) to define various connectionfeatures to improve overmolding will be apparent to those of ordinaryskill in the art in view of the teachings herein. Furthermore, some suchmodifications can include using the various connection featurespresented independently from one another or in other combinations otherthan those depicted in FIGS. 45 and 46.

Sometimes with surgical instruments such as instruments (10, 310) thatuse end effectors as described herein for surgical cutting and stapling,lubricants are applied to the anvil portions of the end effector jaws.Added lubricant can help promote better sliding of the staples along theforming pockets as well as better sliding of the blade or knife throughthe anvil longitudinal channel. In some instances, it may be desirableto remove lubricant from distal portion (20626) where the overmoldingoccurs, or to prevent lubricant from being applied to distal portion(20626) in the first instance. Such removal or prevention of lubricationcan provide for improved overmolding attachment of placement tip (20624)with body or anvil (20620).

In one example, lubricant is applied to body (20620), including distalportion (20626), and then before overmolding, the lubricant is removedfrom distal portion (20626) by an etching application. Etching distalportion (20626) can provided additional benefit in roughening thesurface of distal portion (20626) to promote better bonding of thematerial used for overmolding with distal portion (20626). In anotherexample, distal portion (20626) is masked or covered prior tolubricating body (20620) such that distal portion (20626) remains freeof lubricant. In this way, better overmolding success can be achievedwhere distal portion (20626) remains free of lubricant. Still in anotherexample, combinations of masking and etching can be used. In view of theteachings herein, other ways to lubricate portions of jaw (20618) in atargeted manner such that improved overmolding can be achieved will beapparent to those of ordinary skill in the art.

VII. Surgical Stapling End Effector Component with Deformable Tip HavingVoid

A. Another Exemplary Surgical Instrument Having Various End Effectorsand Placement Tips

FIG. 54 shows another exemplary surgical instrument (30310) configuredas a surgical stapler. Instrument (30310) comprises a handle portion(30320) and a shaft (30322). Shaft (30322) defines a longitudinal axis(LA31) that extends from handle portion (30320). Instrument (30310) hasa modular configuration such that shaft (30322) is selectively removablefrom, and attachable to, handle portion (30320). Instrument (30310) isconfigured similarly to instrument (10), such that the operability anduse of instrument (30310) is the same as described above for instrument(10) with the added feature of instrument (30310) being a modularconfiguration. With its modular configuration, instrument (30310)provides a way to change the desired end effector. Features operable forproviding the modular configuration of instrument (30310) may beconfigured in accordance with at least some of the teachings of U.S.Pub. No. 2017/0086823, entitled “Surgical Stapling Instrument with ShaftRelease, Powered Firing, and Powered Articulation,” published Mar. 30,2017, the disclosure of which is incorporated by reference herein;and/or U.S. Pat. No. 9,913,642, entitled “Surgical Instrument Comprisinga Sensor System,” issued Mar. 13, 2018, the disclosure of which isincorporated by reference herein. In some other versions, shaft (30322)is not detachable from handle portion (30320).

As will be discussed in greater detail below, exemplary end effectors(30312, 30412, 30512) are provided on shaft (30322) that is detachablefrom handle portion (30320). End effectors (30312, 30412, 30512) areoperable to compress, staple, and cut tissue. End effectors (30312,30412, 30512) may be used in place of end effector (12) shown in FIG. 1.In some versions, end effectors (30312, 30412, 30512) may be integrallyformed with shaft (30322) or, alternatively, may be separately formedand then combined. In some versions, end effectors (30312, 30412, 30512)may be provided for use in robotic systems. In such robotic systems,modular shaft (30322) having any of the following end effectors (30312,30412, 30512) may be attachable to a portion of the robotic system foruse such that handle portion (30320) is replaced by components of therobotic system, including a body. Other ways to incorporate an endeffector (30312, 30412, 30512) having any of the following placementtips (30314, 30414, 30514) into a user operated or robotic operatedinstrument will be apparent to those of ordinary skill in the art.

As will be described in greater detail below, placement tips (30314,30414, 30514) are configured to be coupled with an upper jaw (such asanvil 30318, 30418, 30518) or a lower jaw (30316, 30416, 30516).Placement tips (30314, 30414, 30514) may be positioned on the same jawas staple cartridge (37) or on the same jaw as anvil (30318, 30418,30518). Placement tips (30314, 30414, 30514) are operable to elasticallydeform from a first angled position to a second angled position. Thesecond angled position for placement tips (30314, 30414, 30514) may besubstantially straight in some versions, but may be angled to a degree(e.g., slightly above or slightly below the longitudinal axis (LA31,LA32, LA33)) in other versions. The second angled position for placementtips (30314, 30414, 30514) may be defined by the characteristics (e.g.,thickness, density, etc.) of the tissue that is being captured betweenanvils (30318, 30418, 30518) and lower jaws (30316, 30416, 30516) and/orcentral voids (30332, 30436, 30536) that are located at least partiallywithin placement tips (30314, 30414, 30514) as will be discussed ingreater detail below. Central voids (30332, 30436, 30536) allowplacement tips (30314, 30414, 30514) to be formed from stiffer, morerigid, materials. Central voids (30332, 30436, 30536) enable placementtips (30314, 30414, 30514) to deflect in part due to their spatialgeometries. While shown as central voids (30332, 30436, 30536), voidsmay not necessarily be in the geometric center and may be offset adistance from the geometric center.

The exemplary placement tips (30314, 30414, 30514) described below maybe used with any surgical instrument (10, 310) described above and belowand in any of the various procedures described in the various patentreferences cited herein. As will be described in greater detailed below,placement tips (30314, 30414, 30514) may be used singularly or incombination with other placement tips, such as placement tips (30314,30414, 30514). To this end, like numbers below indicate like featuresdescribed above. Except as otherwise described below, instrument (30310)described below may be constructed and operable like instrument (10)described above. Certain details of instrument (30310) will therefore beomitted from the following description, it being understood that suchdetails are already provided above in the description of instrument(10). Other suitable ways in which various surgical instruments may beused will be apparent to those of ordinary skill in the art in view ofthe teachings herein.

1. Another Exemplary Surgical Instrument Having Another Exemplary EndEffector and Another Example of a Placement Tip

FIGS. 54-58B show another exemplary surgical instrument (30310) thatcomprises another exemplary end effector (30312) and another exemplaryplacement tip (30314). FIGS. 55-57 show enlarged views of a distal endof end effector (30312) shown in FIG. 54. As shown, end effector (30312)includes an upper jaw (shown as including an anvil (30318)), and a lowerjaw (30316). While anvil (30318) is included in an upper jaw, andcartridge (30324) is received in lower jaw (30316), this relationshipmay be reversed. Lower jaw (30316) is shown schematically in FIG. 55,and in greater detail in FIG. 56. Staple cartridge (30324) is removablycoupled with lower jaw (30316). As described above with respect tostaple cartridge (37), staple cartridge (30324) is configured to holdone or more staples.

At least one of anvil (30318) or lower jaw (30316) is movable relativeto other of anvil (30318) or lower jaw (30316) between an openconfiguration and a closed configuration. As shown, anvil (30318)pivotably rotates toward lower jaw (16) in the same manner as anvil (18)as described above with respect to instrument (10). In this manner, endeffector (30312) is similar to end effector (12), however, placement tip(30314) is elastically deformable. Placement tip (30314) obtains a firstangled position, shown in FIGS. 55 and 56, when end effector (30312) isnot clamping tissue. In this first angled position, end effector (30312)may be in an open configuration as shown in FIG. 54, or a closedconfiguration as shown in FIGS. 55 and 56. Specifically regarding theclosed configuration, FIG. 56 shows distal tip (30336) is in contactwith angled surface (30340). In instances when end effector (30312) isin this angled configuration, end effector (30312) may be considered ina non-loaded state or non-loaded position. Conversely, in a secondangled position when end effector (30312) is clamping tissue, endeffector (30312) may be considered in a loaded state or a loadedposition. In the second angled position, at least a portion of placementtip (30314) deflects upwardly.

Placement tip (30314) is located adjacent at least one of distal end(30321) of the anvil (30318) or a distal end of lower jaw (30316). Asshown in FIGS. 55-57, placement tip (30314) is coupled with a distal end(30321) of anvil (30318). As shown in FIG. 13, lower jaw (30316) isthicker (i.e. vertically taller) than anvil (30318) or placement tip(30314). As shown in the top view of FIG. 57, lower jaw (30316) islonger and wider than anvil (30318) and placement tip (30314).Additionally, as shown in FIG. 57, placement tip (30314) is symmetricabout a longitudinal axis (LA31). However, placement tip (30314) may benon-symmetric, if desired. Placement tip (30314) may be integrallyformed together as unitary piece.

Placement tip (30314) includes first and second legs (30326, 30328) anda distal portion (30330). As shown, first and second legs (30326, 30328)extend distally from anvil (30318). First and second legs (30326, 30328)are separated by central void (30332), which is shown as extendingcompletely through placement tip (30314). With reference to FIG. 58A,first and second legs (30326, 30328) have a generally L-shapedcross-section. Additionally, first and second legs (30326, 30328) eachhave a first width (W31) shown in FIG. 58A that is less than a secondwidth (W32) of a central void (30332) shown in FIG. 57. Central void(30332) is defined by an inner wall (30334) extending through placementtip (30314). While FIG. 57 shows central void (30332) being generallypentagon shaped when viewed from above, central void (30332) may have avariety of different shapes and/or sizes depending on the desired degreeof upward flexibility according to the specific orientation shown.Additionally, while inner wall (30334) forming central void (30332) isshown as extending generally perpendicular to longitudinal axis (LA31)of placement tip (30314), inner wall (30334) may alternatively beangled, if desired.

Distal portion (30330) of placement tip (30314) connects first andsecond legs (30326, 30328). As shown in FIGS. 58A-58B, distal portion(30330) has a first cross-sectional height (H31) that is greater thansecond cross-sectional height (H32) of first and second legs (30326,30328). Since H31 is greater than H32, placement tip (30314) iselastically deformable. More specifically, since distal portion (30330)has a first cross-sectional height (H31) that is greater than secondcross-sectional height (H32) of first and second legs (30326, 30328),the first and second legs (30326, 30328) deflect before distal portion(30330) deflects, allowing distal portion (30330) to remain generallyrigid. Additionally, central void (30332) allows first and second legs(30326, 30328) of placement tip (30314) to deflect upwardly when incontact with tissue. This spatial geometry of placement tip (30314)allows placement tip (30314) to be formed from a rigid material, whilestill retaining the desired degree of flexibility.

Additionally, distal portion (30330) of placement tip (30312) terminatesat distal most point (30336), which may be blunt or sharp. When distaltip (30336) is rigid, such as when a portion of or the entire placementtip (30314) is formed from a rigid material, distal tip (30336) allowsfor jabbing at small areas of tissue and subsequent dilatation of thearea of tissue as placement tip (30314) is advanced distally.Additionally, in the closed configuration, since distal portion (30330)maybe in contact with lower jaw (30316), distal tip (30336) may be sharpbecause distal tip (30336) is shielded from damaging tissue by lower jaw(30316). In other versions, placement tip (30312) is deformable. Suchdeformability may be elastic or malleable.

2. Another Exemplary Surgical Instrument Having Another Exemplary EndEffector and Another Example of a Placement Tip

FIGS. 59-63B show another exemplary end effector (30412) and anotherexemplary placement tip (30414). As shown, end effector (30412)comprises upper and lower opposing jaws, a staple cartridge (30437)similar to staple cartridge (37, 30324), and placement tip (30414).While the upper jaw includes anvil (30418) and lower jaw (30416) acceptsstaple cartridge (30437), this relationship may be reversed. Placementtip (30414) may be permanently coupled with or removably coupled with ananvil (30418). Lower jaw (30416) is similar to lower jaw (16). Staplecartridge (30437) is removably coupled with lower jaw (30416) in asimilar manner to staple cartridge (37) and lower jaw (16) and isconfigured to hold one or more staples.

At least one of anvil (30418) or lower jaw (30416) is movable relativeto other of anvil (30418) or lower jaw (30416) between an openconfiguration and a closed configuration. As shown, anvil (30418)pivotably rotates toward lower jaw (30416) in the same manner as anvil(18) as described above with respect to instrument (10). In this manner,end effector (30412) is like end effector (12). However, placement tip(30414) is elastically deformable. Placement tip (30414) assumes a firstangled position, shown in FIG. 63A, when end effector (30412) is notclamping tissue. In this first angled position, end effector (30412) maybe in an open configuration like what is shown in FIG. 54; or a closedconfiguration as shown in FIG. 63A where placement tip (30414) is incontact with staple cartridge (30437) of lower jaw (30416). In instanceswhen end effector (30412) is in the first angled configuration, endeffector (30412) may be considered in a non-loaded state or non-loadedposition. Conversely, while not shown, in a second angled position whenend effector (30412) is clamping tissue, end effector (30412) may beconsidered in a loaded state or a loaded position. In the second angledposition, at least a portion of placement tip (30414) deflects upwardly.

Placement tip (30414) is located adjacent at least one of distal end(30450) of the anvil (30418) or a distal end of lower jaw (30416). Asshown in FIGS. 61-63B, placement tip (30414) is coupled with a distalend (30421) of anvil (30418). As shown in FIGS. 63A-63B, lower jaw(30416) is thicker (i.e. vertically taller) than anvil (30418) orplacement tip (30414). Additionally, as shown in the top view of FIG.61, lower jaw (30416) is longer and wider than anvil (30418) andplacement tip (30414). As shown in FIG. 61, placement tip (30414) issymmetric about a longitudinal axis (LA32). However, placement tip(30414) may be non-symmetric, if desired.

FIGS. 59-63B show placement tip (30414) as including a body portion(30420) and a malleable member (30422). Body portion (30420) includesproximal and distal portions (30424, 30426) separated by first andsecond legs (30428, 30430). Body portion (30420) is formed between anouter perimeter (30432) and an inner perimeter (30434) of placement tip(30414). Inner perimeter (30434) is defined by a central void (30436)extending through placement tip (30412). At least a portion of distalportion (30426) of body portion (30420) is bent towards the opposingjaw, shown as lower jaw (30416). At least body portion (30420) ofplacement tip (30314) may be integrally formed together as unitarypiece.

Additionally, as shown in FIGS. 59-62, and more clearly in the top viewsof FIGS. 61-62, each of body portion (30420) and central void (30436)have a generally oval shape when viewed from the top. In the exampleshown, central void (30436) is egg-shaped and is wider adjacent proximalportion (30424) than adjacent distal portion (30426). Additionally,central void (30436) formed by inner perimeter (30434) forms a full oval(i.e. a 360-degree oval). Body portion (30420) is oval shaped and formsabout half oval (i.e. a 180-degree oval). As shown in FIG. 62, thedistance (D30) between outer perimeter (30432) and inner perimeter(30434) is generally uniform. Placement tip (30414) includes a bend(30438) disposed along longitudinal axis (LA32) producing a bent ovalplacement tip shape at least in the first angled state shown in FIGS.59-60 and 63A-63B. As shown in FIGS. 63A-63B, bend (30438) directsplacement tip (30414) toward staple cartridge (30437) of lower jaw(30416).

As shown in FIGS. 59-60, malleable member (30422) fits in a generallyU-shaped channel (30440) disposed in outer perimeter (30432) of bodyportion (30420). Channel (30440) may take the form of a variety ofshapes and sizes and may even be entirely omitted. As shown in FIG. 60,malleable member (30422) includes first and second legs (30440, 30442)and generally U-shaped portion (30446) configured to contact outerperimeter (30432) of body portion (30420). Malleable member (30422) alsoincludes first and second bent portions (30446, 30448). Malleable member(30422) allows for ad hoc customization of the bend angle.

As previously described, malleable member (30422) may be removablycoupled with at least one of placement tip (30414) or the jaw thatincludes placement tip (30414), which is shown as such as anvil (30418).Alternatively, while not shown, if placement tip (30414) is desired tobe coupled with lower jaw (30416), malleable member (30422) may beremovably coupled with at least one of placement tip (30414) or lowerjaw (30416). Distal end (30450) of anvil (30418) includes at least onecoupling feature that is configured to mate with at least one couplingfeature of malleable member (30422). As shown, the coupling features ofmalleable member (30422) include first and second barbed fittings(30452, 30454). The coupling features disposed at distal end (30450) ofanvil (30418) are configured to be in locking engagement with first andsecond corresponding receptacles (30456, 30458) configured to securablycouple with first and second barbed fittings (30452, 30454). For thisreason, the interior of first and second receptacles (30456, 30458) mayinclude a non-smooth surface.

As shown in FIGS. 63A-63B, malleable member (30422) is configured toincrease the rigidity of placement tip (30414) and allow an operator tocustomize the shape of placement tip (30414) by producing differentangles of placement tip (30414). For example, FIG. 63A may refer to apre-customized standard angle alpha (α31), while FIG. 63B may refer to apost-customized angle beta (β31). As shown, angle alpha (α32) is lessthan angle beta (β32). As shown in the pre-customized configuration ofFIG. 63A, a distal end (30460) of cartridge (30437) extends a firstdistance (D31) beyond distal portion (30426) of placement tip (30414).Angled surface (30464) of cartridge (30437) is in contact with a distalportion (30426) of placement tip (30414). However, in thepost-customized configuration of FIG. 63B, distal portion (30426) ofplacement tip (30414) extends a second distance (D32) beyond distal end(30460) of cartridge (30437). Distal tip (30462) of malleable member(30422) may extend beyond distal portion (30426) of body portion(30420). Additionally, it is envisioned that the operator may usedifferent malleable members (30422) having various different stiffnessesto obtain the desired amount of rigidity of placement tip (30414).

3. Another Exemplary Surgical Instrument Having Another Exemplary EndEffector and Another Example of a Placement Tip

FIGS. 64-66B show another exemplary end effector (30512) that comprisesan upper jaw, a lower jaw (30516), a staple cartridge (30537) (likestaple cartridge (37)), and another exemplary placement tip (30514). Asshown, the upper jaw includes anvil (30518). Lower jaw (30516) is likelower jaw (16). Staple cartridge (30537) is removably coupled with lowerjaw (30516) in a similar manner and function as lower jaw (16) andstaple cartridge (37) described above. Staple cartridge (30537) isconfigured to hold one or more staples. At least one of anvil (30518) orlower jaw (30516) is movable relative to other of anvil (30518) or lowerjaw (30516) between an open configuration (shown in FIG. 54 with respectto end effector (30312)) and a closed configuration shown in FIGS.66A-66B. Anvil (30518) pivotably rotates toward lower jaw (30516) in asimilar manner as anvil (18) as described above with respect toinstrument (10). End effector (30512) is thus like effector (12), butwith anvil (30518) comprising placement tip (30514) that is elasticallydeformable. While not shown, placement tip (30514) may be locatedadjacent one or both of a distal end (30550) of the anvil (30518) or adistal end of lower jaw (30516).

As shown in 64-66B, placement tip (30514) includes a body portion(30520) and a malleable member (30522). Placement tip (30514) is likeplacement tip (30414) described above, but malleable member (30522) ispermanently coupled with body portion (30520). Body portion (30520)includes proximal and distal portions (30524, 526) separated by firstand second legs (30528, 30530). Body portion (30520) is formed betweenan outer perimeter (30532) and an inner perimeter (30534) of placementtip (30514). Inner perimeter (30534) is defined by a central void(30536) extending through placement tip (30512). At least a portion ofdistal portion (30526) of body portion (30520) is bent toward theopposing jaw, shown as lower jaw (30516). As shown in FIG. 65, thedistance between inner perimeter (30534) and outer perimeter (30532) isgenerally uniform.

As shown in the top view of FIG. 65, each of body portion (30520) andcentral void (30536) have a generally oval shape when viewed from thetop. Central void (30536) is egg shaped and is wider adjacent proximalportion (30524) than adjacent distal portion (30526). Additionally,central void (30536), which is formed by inner perimeter (30534), formsa full oval (i.e. a 360-degree oval). Body portion (30520) is ovalshaped and forms about half oval (i.e. a 180-degree oval). Like FIG. 62regarding distance (D33), the distance between outer perimeter (30532)and inner perimeter (30534) is generally uniform. Placement tip (30514)includes a bend (30538) disposed along a longitudinal axis (LA33)producing a bent oval shape for placement tip (30514). As shown,placement tip (30514) is generally formed from a rigid material. Asshown in FIG. 65, placement tip (30514) is symmetric about longitudinalaxis (LA33). Alternatively, placement tip may be non-symmetric ifdesired. As shown in FIGS. 63A-63B, lower jaw (30516) is thicker thananvil (30518) that includes placement tip (30514). Additionally, asshown in FIG. 65, lower jaw (30516) is longer and wider than anvil(30518) and placement tip (30514).

In the present example, body portion (30520) of placement tip (30514) isintegrally formed together with malleable member (30522). As shown inFIG. 60, malleable member (30522) includes first and second legs (30540,30542) and a generally U-shaped portion (30544) disposed within bodyportion (30520). Malleable member (30522) also includes a bent portion(30548) shown in FIG. 66B. Malleable member (30522) allows for ad hoccustomization of the bend angle. As previously described, placement tip(30514) may be removably coupled with or integrally formed with theanvil (30518). As shown, distal end (30552) of anvil (30518) includesfirst and second coupling features (30554, 30556) that are configured tomate with first and second legs (30540, 542) of malleable member(30522).

In the present example, malleable member (30522) is comprised of amalleable metal. Body portion (30520) may be comprised of variousmetals, plastic, ceramic, combinations of metal with plastic or ceramic,and other suitable materials or combinations of materials that will beapparent to those of ordinary skill in the art in view of the teachingsherein. Additionally, body portion (30520) in some versions is entirelyrigid, yet in other versions body portion (30520) may be resilient to alesser extent than malleable member (30522). During the molding process,material flows through and fills mold surrounding malleable member(30522). In this manner, malleable member (30522) is securely connectedwith body portion (30520) during the overmolding process. Alternatively,if less rigidity is desired, body portion (30520), may comprise rubber,plastic, or any other suitable natural or synthetic material having thedesired elastomeric properties.

As shown in FIGS. 66A-66B, malleable member (30522) is configured toincrease the rigidity of placement tip (30514) and allow an operator tocustomize the shape of placement tip (30514) by producing differentangles of placement tip (30414). For example, FIG. 66A may refer to apre-customized standard angle alpha (α32), while FIG. 66B may refer to apost-customized angle beta (β32). As shown, angle alpha (α32), is lessthan angle beta (β32). As shown in FIG. 66A in the pre-customizedconfiguration, a distal end (30558) of cartridge (30537) extends a thirddistance (D34) beyond distal portion (30526) of placement tip (30514).Angled surface (30560) of cartridge (30537) is in contact with a distalportion (30526) of placement tip (30514). However, as shown in FIG. 66Bin the post-customized configuration, distal portion (30526) ofplacement tip (30514) extends a fourth distance (D35) beyond distal end(30558) of cartridge (30537).

VIII. Surgical Stapling End Effector Component with Deformable TipSkewing in Multiple Planes

A. Another Exemplary Surgical Instrument Including End Effector withPlacement Tip

FIGS. 67-81 show another exemplary instrument (40310) with exemplary endeffectors (40312, 40412, 40512) and exemplary placement tips (40314,40414, 40514). Instrument (40310) may have a modular configuration suchthat shaft (40322) is selectively removable from, and selectivelyattachable to, handle portion (40320). Instrument (40310) is configuredsimilarly to instrument (10), such that the operability and use ofinstrument (40310) is the same as described above for instrument (10)with the added feature of instrument (40310) having a modularconfiguration. With its modular configuration, instrument (40310)provides a way to change the desired end effector. Features operable forproviding the modular configuration of instrument (40310) may beconfigured in accordance with at least some of the teachings of U.S.Pub. No. 2017/0086823 entitled “Surgical Stapling Instrument with ShaftRelease, Powered Firing, and Powered Articulation,” published Mar. 30,2017, the disclosure of which is incorporated by reference herein;and/or U.S. Pat. No. 9,913,642, entitled “Surgical Instrument Comprisinga Sensor System,” issued Mar. 13, 2018, the disclosure of which isincorporated by reference herein. In some other versions, shaft (40322)is not detachable from handle portion (40320).

As will be discussed in greater detail below, end effectors (40312,40412, 40512) are provided on shaft (40322) that is detachable fromhandle portion (40320). End effectors (40312, 40412, 40512) are operableto compress, staple, and cut tissue. End effectors (40312, 40412, 40512)may be used in place of end effector (12) shown in FIG. 1. In someversions, end effectors (40312, 40412, 40512) may be integrally formedwith shaft (40322) or, alternatively, may be separately formed andsubsequently combined. In some versions, end effectors (40312, 40412,40512) may be provided for use in robotic systems. In such roboticsystems, modular shaft (40322) having any of the following end effectors(40312, 40412, 40512) may be attachable to a portion of the roboticsystem for use such that handle portion (40320) is replaced bycomponents of the robotic system, including a body. Other ways toincorporate end effectors (40312, 40412, 40512) having any of thefollowing placement tips (40314, 40414, 40514) into a user operated orrobotic operated instrument will be apparent to those of ordinary skillin the art.

Placement tips (40314, 40414, 40514) are operable to elastically deformfrom a non-deflected position to a deflected position. Placement tips(40314, 40414, 40514) obtain the non-deflected position when endeffectors (40312, 40412, 40512) are not clamping tissue. Morespecifically, in this non-deflected position, end effectors (40312,40412, 40512) may be in the open configuration as shown in FIG. 67, orin the closed configuration as shown in FIGS. 8 and 9 with respect toend effector (212). In instances when end effectors (40312, 40412,40512) are in this non-deflected position, end effectors (40312, 40412,40512) may be considered in a non-loaded state or non-loaded position.Conversely, in the deflected position (not shown) when end effectors(40312, 40412, 40512) are clamping tissue, end effectors (40312, 40412,40512) may be considered in a loaded state or a loaded position. In thedeflected position, at least a portion of placement tips (40314, 40414,40514) deflect upwardly. The deflected position for placement tips(40314, 40414, 40514) may be substantially straight in some versions,but may be deflected to a degree (e.g., slightly above or slightly belowend effector axis (EEA41, EEA42, EEA43)) in other versions. It should beunderstood that the deflected position for placement tips (40314, 40414,40514) may be defined by the characteristics (e.g., thickness, density,etc.) of the tissue that is being captured between respective lower jaws(40316, 40416, 40516) and anvils (40318, 40418, 40518), thereby causingthe deflection of placement tips (40314, 40414, 40514). In somevariations, placement tips (40314, 40414, 40514) do not deflect inresponse to a load.

The placement tips (40314, 40414, 40514) described below may be usedwith any surgical instrument (10, 40310) described above and below andin any of the various procedures described in the various patentreferences cited herein. As will be described in greater detailed below,placement tips (40314, 40414, 40514) may be used singularly or incombination with other placement tips, such as placement tips (40314,40414, 40514). To this end, like numbers below indicate like featuresdescribed above. Except as otherwise described below, instrument (40310)described below may be constructed and operable like instrument (10)described above. Certain details of instrument (40310) will therefore beomitted from the following description, it being understood that suchdetails are already provided above in the description of instrument(10). Other suitable ways in which various surgical instruments may beused will be apparent to those of ordinary skill in the art in view ofthe teachings herein.

1. Another Exemplary Surgical Instrument Including Another End Effectorwith Another Example of a Placement Tip

FIGS. 67-70 show surgical instrument (40310), configured as a surgicalstapler, that comprises another exemplary end effector (40312) andanother exemplary placement tip (40314). End effector (40312) includesan upper jaw and a lower jaw (40316), with the upper jaw including ananvil (40318). Instrument (40310) additionally includes a body, shown asa handle portion (40320), and a shaft (40322) that extends from handleportion (40320). As shown in FIG. 67, shaft (40322) defines alongitudinal axis (LA41) that is colinear with an end effector axis(EEA41) of end effector (40312), but which may non-colinear, and insteadangled, when end effector (40312) is articulated relative to shaft(40322) using articulation joint (40323).

FIGS. 68-70 show enlarged views of a distal end of end effector (40312).Placement tip (40314) is located adjacent at least one of a distal end(40321) of anvil (40318) or a distal end of lower jaw (40316). As shownin FIGS. 67-70, placement tip (40314) is coupled with distal end (40321)of anvil (40318). Placement tip (40314) may be permanently coupled withanvil (40318), or alternatively, placement tip (40314) may be removablycoupled with anvil (40318). Placement tip (40314) may be integrallyformed together with anvil (40318) as unitary piece or consist ofseparately formed components. Placement tip (40314) may be positioned onthe same jaw as staple cartridge (40324) or on the same jaw as anvil(40318). As shown in FIG. 67, upper jaw includes anvil (40318), whilelower jaw (40316) is removably coupled with staple cartridge (40324).However, this relationship may be reversed if desired. Staple cartridge(40324) is configured to hold one or more staples in a manner similar tostaple cartridge (37). As previously described, at least one of anvil(40318) or lower jaw (40316) is movable relative to other of anvil(40318) or lower jaw (40316) between the open configuration and theclosed configuration. As shown, anvil (40318) pivotably rotates towardlower jaw (40316) in the same manner as anvil (18) as described abovewith respect to instrument (10). In this manner, end effector (40312) islike end effector (12), except for the laterally deflected configurationand deformability of placement tip (40314).

FIGS. 68-69 show placement tip (40314) as including a proximal portion(40326), a central portion (40328), and a distal portion (40330).Proximal portion (40326) extends distally from distal end (40321) ofanvil (40318) and is disposed opposite from lower jaw (40316). Centralportion (40328) is disposed longitudinally between proximal and distalportions (40326, 40330). Central portion (40328) and distal portion(40330) of placement tip (40314) each include an asymmetric profilealong longitudinal axis of end effector (40312), i.e. end effector axis(EEA41). FIGS. 68 and 70 show central portion (40328) tapering inwardlyalong an inwardly tapering portion (40332) on the left side (when viewedfrom above), then tapering outwardly along an outwardly tapering portion(40334). The radius of curvature of the inwardly and outwardly taperingportions (40332, 40334) may be constant or changing. Additionally, asshown in FIG. 68, the opposite right side (when viewed from above)extends arcuately toward distal portion (40330). As shown, placement tip(40314) terminates at a tip end (40336). Placement tip (40314) is thusgenerally C-shaped in this example. As shown in FIG. 69, in the closedconfiguration, a contacting portion (40338) of distal portion (40330) isin abutting contact with a distal angled surface (40325) of staplecartridge (40324). Alternatively, a gap may exist between placement tip(40314) and distal angled surface (40325) of staple cartridge (40324).Also, an underside surface (40339) of placement tip (40314) is disposedat an angle relative to distal angled surface (40325) of staplecartridge (40324). In other words, underside surface (40339) is notparallel to distal angled surface (40325); but may be parallel ifdesired.

Placement tip (40314) generally follows a curvilinear path (CP41) alongproximal, central, and distal portions (40326, 40328, 40330) toward tipend (40336). FIG. 70 and the cross-sections of FIGS. 71-76 showsuccessive perimeters of anvil (40318) or placement tip (40314) takenperpendicular to curvilinear path (CP41). More specifically, FIG. 71shows a cross-section of anvil (40318), while FIGS. 72-76 showcross-sections of placement tip (40314) taken at various locations alongproximal, central, and distal portions (40326, 40328, 40330). Theperimeters of the successive cross-sections of FIGS. 71-76 decreasemoving along curvilinear path (CP41) toward tip end (40336). Forexample, the perimeter of the cross-section shown in FIG. 71 is greaterthan the perimeter of the cross-section shown in FIG. 72, which isgreater than the perimeter of the cross-section shown in FIG. 73, whichis greater than the perimeter of the cross-section shown in FIG. 74.Likewise, the perimeter of the cross-section shown in FIG. 74 is greaterthan the perimeter of the cross-section shown in FIG. 75, which isgreater than the perimeter of the cross-section shown in FIG. 76.

Regarding the lateral widths shown in FIG. 70, distal portion (40330) ofplacement tip (40314) has a lateral width that is greater than thelateral width of the opposing jaw, shown as lower jaw (40316). As usedherein, the lateral width is measured perpendicular to end effector axis(EEA41). More specifically, as shown in FIG. 70, proximal portion(40326) has a proximal tip width (PTW41) that is less than a jaw width(JW41) of lower jaw (40316) disposed opposite placement tip (40314). Forexample, proximal tip width (PTW41) may be measured where placement tip(40314) couples with distal end (40321) of anvil (40318). As shown inFIGS. 70-71, proximal tip width (PTW41) has the same lateral width asanvil (40318). Central portion (40328) has a lateral width that is lessthan the lateral width of proximal portion (40326).

Distal portion (40330) has a distal tip width (DTW41) depicted in thecross-section of FIG. 77 that is greater than jaw width (JW41) of lowerjaw (40316) disposed opposite placement tip (40314). Unlike thecross-sections of FIGS. 72 and FIGS. 74-76 that are taken perpendicularto curvilinear path (CP41) but are not perpendicular to end effectoraxis (EEA41), FIG. 77 is taken perpendicular to end effector axis(EEA41), similar to FIGS. 71 and 73. As shown in FIG. 70, distal portion(40330) includes an overhang portion (40348) that extends beyond theopposite jaw only on a single lateral side. However, an angled portion(40350) may extend laterally beyond the width of lower jaw (40316) orthe width of staple cartridge (40324), such that placement tip (40314)extends beyond both lateral sides (i.e. left and right sides) of lowerjaw (40316) or staple cartridge (40324). Tip end (40336) includes aproximal surface (40340) and a distal surface (40342), with proximalsurface (40340) extending adjacent outwardly tapering portion (40334).Additionally, as shown in FIGS. 69 and 70, a distal tip (40341) ofstaple cartridge (40324) extends distally beyond distal surface (40342)of tip end (40336). In other words, lower jaw (40316) extends distallybeyond tip end (40336) of placement tip (40314). However, lower jaw(40316) may be shorter and/or and narrower than anvil (40318) andplacement tip (40314) if desired.

Distal portion (40330) includes a tip axis (TA41) defined by thedirection that tip end (40336) of distal portion (40330) extends. In theexample shown, tip axis (TA41) is measured using proximal surface(40340) of placement tip (40314). Alternatively, other surfaces (e.g.distal surface (40342)) may also be used. As shown in FIG. 70, tip axis(TA41) is generally perpendicular to end effector axis (EEA41) andlongitudinal axis (LA41) of shaft (40322). In other words, the anglebeta (β40) formed between tip end (40336) and end effector axis (EEA41)is about 90 degrees. However, this non-zero angle may vary. As shown inFIGS. 68 and 70, given the geometry of placement tip (40314), distalportion (40330) of placement tip (40314) is configured to deflectproximally as placement tip (40314) is advanced distally through thetrocar of a patient.

2. Another Exemplary Surgical Instrument Including Another End Effectorwith Another Example of a Placement Tip

FIGS. 78-80 show another exemplary end effector (40412) and anotherexemplary placement tip (40414). End effector (40412) and placement tip(40414) are similar to end effector (40312) and placement tip (40314)described in connection to FIGS. 67-77 with notable differencesindicated below. End effector (40412) includes placement tip (40414), alower jaw (40416), an anvil (40418), a distal end (40421), a staplecartridge (40424), a distal angled surface (40425), a proximal portion(40426), a central portion (40428), a distal portion (40430), aninwardly tapering portion (40432), an outwardly tapering portion(40434), a tip end (40436), an underside surface (40439), a proximalsurface (40440), a distal surface (40442), and an angled portion(40450).

As shown in FIG. 78, the upper jaw includes anvil (40418), and lower jaw(40416) is like lower jaw (16, 40316). Staple cartridge (40424) isremovably coupled with lower jaw (40416) in a similar manner andfunction as lower jaws (16, 40316) and staple cartridges (37, 40324)described above. At least one of lower jaw (40416) or anvil (40418) ismovable relative to the other of lower jaw (40416) or anvil (40418)between an open configuration (shown in FIG. 67 with respect to endeffector (40312)) and a closed configuration (shown in FIGS. 78-79).Anvil (40418) pivotably rotates toward lower jaw (40416) in a similarmanner to anvils (18, 40318) as described above with respect toinstruments (10, 40310). End effector (40412) is thus like effector(12), but with anvil (40418) comprising placement tip (40414) that iselastically deformable. While not shown, placement tip (40414) may belocated adjacent one or both of distal end (40421) of anvil (40418) or adistal end of lower jaw (40416).

FIGS. 78-80 show placement tip (40414) as including proximal, central,and distal portions (40426, 40428, 40430). Proximal portion (40426)extends distally from distal end (40421) of anvil (40418) and isdisposed opposite from lower jaw (40416). Central portion (40428) isdisposed longitudinally between proximal and distal portions (40426,430). Central portion (40428) and distal portion (40430) of placementtip (40414) each include an asymmetric profile along an end effectoraxis (EEA42). As shown in FIGS. 78 and 80, central portion (40428)tapers inwardly along inwardly tapering portion (40432), then tapersoutwardly along outwardly tapering portion (40434). The radius ofcurvature of inwardly and outwardly tapering portions (40432, 40434) maybe constant or changing. Additionally, as shown in FIG. 80, the oppositeside extends arcuately toward distal portion (40430). Placement tip(40414) terminates at tip end (40436). Similar to placement tip (40314)described relative to FIGS. 70-76, successive perimeters of placementtip (40414) taken perpendicular to curvilinear path (CP2) decreasemoving toward tip end (40436).

As shown in FIG. 78, distal portion (40430) extends downwardly at anoverhang portion (40444) toward lower jaw (40416) and staple cartridge(40424), in a manner that differs from placement tip (40314). Moreover,as shown in FIG. 79, a projection (40446) of distal portion (40430)extends below distal angled surface (40425) of staple cartridge (40424)and approaches a bottom surface (40438) of staple cartridge (40424). Asshown, tip end (40436) extends parallel to and is separated a distancefrom a tapered side surface (40448) of staple cartridge (40424) in theclosed configuration. Alternatively, tip end (40436) may extend parallelto and be in contact with tapered side surface (40448) of staplecartridge (40424) in the closed configuration.

Regarding the lateral widths shown in FIG. 80, distal portion (40430) ofplacement tip (40414) has a lateral width that is less than the lateralwidth of the opposing jaw, shown as lower jaw (40416). As used herein,the lateral width is measured perpendicular to end effector axis(EEA42). More specifically, as shown in FIG. 80, proximal portion(40426) has a proximal tip width (PTW42) that is less than a jaw width(JW42) of lower jaw (40416) disposed opposite placement tip (40414).Proximal tip width may be measured where placement tip (40414) coupleswith distal end (40421) of anvil (40418). Additionally, distal portion(40430) has a distal tip width (DTW42) that is less than jaw width(JW42) of lower jaw (40416) disposed opposite placement tip (40414).

Additionally, distal portion (40430) includes overhang portion (40444)that extends beyond the opposite jaw only on one lateral side. However,an angled portion (40435) may extend laterally beyond the width of lowerjaw (40416) or the width of staple cartridge (40424), such thatplacement tip (40414) extends beyond both lateral sides of lower jaw(40416) or staple cartridge (40424). Central portion (40428) has alateral width that is less than the lateral width of proximal portion(40426). Additionally, lower jaw (40416) extends distally beyond tip end(40436) of placement tip (40414). More specifically, as shown in FIG.79, a distal tip (40441) of staple cartridge (40424) extends distallybeyond distal surface (40442) of tip end (40436). However, lower jaw(40416) may be shorter and/or and narrower than anvil (40418) andplacement tip (40414) if desired.

3. Another Exemplary Surgical Instrument Including Another End Effectorwith Another Example of a Placement Tip

FIG. 81 shows another exemplary end effector (40512) and anotherexemplary placement tip (40514). End effector (40512) and placement tip(40514) are similar to end effector (40312) and placement tip (40314)described in connection to FIGS. 67-77 with notable differencesindicated below. End effector (40512) includes placement tip (40514), alower jaw (40516), an anvil (40518), a distal end (40521), a staplecartridge (40524), a distal angled surface (40525), a proximal portion(40526), and a distal portion (40530).

As shown in FIG. 81, the upper jaw includes anvil (40518), and lower jaw(40516) is like lower jaws (16, 40316). Staple cartridge (40524) isremovably coupled with lower jaw (40516) in a similar manner andfunction as lower jaws (16, 40316) and staple cartridges (37, 40324)described above. At least one of lower jaw (40516) or anvil (40518) ismovable relative to the other of lower jaw (40516) or anvil (40518)between an open configuration (shown in FIG. 67 with respect to endeffector (40312)) and a closed configuration (shown generally in FIG.81). Anvil (40518) pivotably rotates toward lower jaw (40516) in asimilar manner to anvils (18, 40318) as described above with respect toinstruments (10, 40310). End effector (40512) is thus like effector(12), but with anvil (40518) comprising placement tip (40514) that iselastically deformable. While not shown, placement tip (40514) may belocated adjacent one or both of distal end (40521) of anvil (40518) or adistal end of lower jaw (40516).

FIG. 81 shows placement tip (40514) as including proximal and distalportions (40526, 40530) that are each symmetric along an end effectoraxis (EEA43). Proximal portion (40526) extends distally from distal end(40521) of anvil (40518) and is disposed opposite from lower jaw(40516). Distal portion (40530) tapers outwardly along outwardlytapering portions (40532 a-b), then tapers inwardly along inwardlytapering portions (40534 a-b). The radius of curvature of inwardly andoutwardly tapering portions (40532 a-b, 40534 a-b) may be constant orchanging. Placement tip (40514) terminates at a tip end that is alongend effector axis (EEA43).

Regarding the lateral widths shown in FIG. 81, distal portion (40530) ofplacement tip (40514) has a lateral width that is greater than thelateral width of the opposing jaw, shown as lower jaw (40516). As usedherein, the lateral width is measured perpendicular to end effector axis(EEA43). More specifically, proximal portion (40526) has a proximal tipwidth (PTW43) that is less than a jaw width (JW43) of lower jaw (40516)disposed opposite placement tip (40514). Proximal tip width (PTW43) maybe measured where placement tip (40514) couples with distal end (40521)of anvil (40518) is shown as the same as an anvil tip width.

Additionally, distal portion (40530) has a distal tip width (DTW43)depicted in the cross-section of FIG. 81 that is greater than jaw width(JW43) of lower jaw (40516) disposed opposite placement tip (40514).Additionally, distal portion (40530) includes first and second overhangportions (40538, 40540) that each extend beyond the lateral width of theopposite jaw on both lateral sides. As shown, placement tip (40514)extends beyond both lateral sides (left and right sides) of both lowerjaw (40516) and staple cartridge (40524). First and second overhangportions (40538, 40540) are symmetric about end effector axis (EEA43).As shown, lower jaw (40516) extends distally beyond tip end (40536) ofplacement tip (40514). However, lower jaw (40516) may be shorter and/orand narrower than anvil (40518) and placement tip (40514) if desired.

IV. Surgical Stapling End Effector Component with Articulation andAsymmetric Deformable Tip

A. Another Exemplary Surgical Instrument Including End Effector withPlacement Tip

FIGS. 82, 83A-83E, and 84A-84D show another exemplary surgicalinstrument (50310), configured as a surgical stapler, that comprisesanother exemplary end effector (50312) and another exemplary placementtip (50314). End effector (50312) includes an upper jaw and a lower jaw(50316), with the upper jaw including an anvil (50318). Instrument(50310) additionally includes a body, shown as a handle portion (50320),and a shaft (50322) that extends from handle portion (50320). As shownin FIGS. 82 and 83A-83E, shaft (50322) defines a longitudinal axis thatis commonly referred to below as a shaft axis (SA50). Except asotherwise described below, instrument (50310) described below may beconstructed and operable like instrument (10) described above. Certaindetails of instrument (50310) will therefore be omitted from thefollowing description, it being understood that such details are alreadyprovided above in the description of instrument (10).

Instrument (50310) may have a modular configuration such that shaft(50322) is selectively removable from, and selectively attachable to,handle portion (50320). Instrument (50310) is configured similarly toinstrument (10), such that the operability and use of instrument (50310)is the same as described above for instrument (10) with the addedfeature of instrument (50310) having a modular configuration. With itsmodular configuration, instrument (50310) provides a way to change thedesired end effector. In addition to or in lieu of the foregoing,features operable for providing the modular configuration of instrument(50310) may be configured in accordance with at least some of theteachings of U.S. Pub. No. 2017/0086823 entitled “Surgical StaplingInstrument with Shaft Release, Powered Firing, and PoweredArticulation,” published Mar. 30, 2017, the disclosure of which isincorporated by reference herein; and/or U.S. Pat. No. 9,913,642,entitled “Surgical Instrument Comprising a Sensor System,” issued Mar.13, 2018, the disclosure of which is incorporated by reference herein.In some other versions, shaft (50322) is not detachable from handleportion (50320).

As discussed in greater detail below, end effector (50312) is providedon shaft (50322) and is operable to compress, staple, and cut tissue.End effector (50312) may be used in place of end effector (12) shown inFIG. 1. In some versions, end effector (50312) may be integrally formedwith shaft (50322) or, alternatively, may be separately formed andsubsequently combined. In some versions, end effector (50312) may beprovided for use in robotic systems. In such robotic systems, modularshaft (50322) having end effector (50312) may be attachable to a portionof the robotic system for use such that handle portion (50320) isreplaced by components of the robotic system, including a body. Otherways to incorporate an end effector (50312) having placement tip (50314)into a user operated or robotic operated instrument will be apparent tothose of ordinary skill in the art.

Placement tip (50314) is operable to elastically deform from anon-deflected position to a deflected position. Placement tip (50314)obtains the non-deflected position when end effector (50312) is notclamping tissue. More specifically, in this non-deflected position, endeffector (50312) may be in the open configuration as shown in FIG. 83,or in the closed configuration as shown in FIGS. 8 and 9 with respect toend effector (212). In instances when end effector (50312) is in thisnon-deflected position, end effector (50312) may be considered in anon-loaded state or non-loaded position. Conversely, in the deflectedposition (not shown) when end effector (50312) is clamping tissue, endeffector (50312) may be considered in a loaded state or a loadedposition. In the deflected position, at least a portion of placement tip(50314) deflects upwardly. The deflected position for placement tip(50314) may be substantially straight in some versions, but may bedeflected to a degree (e.g., slightly above or slightly below shaft axis(SA50)) in other versions. It should be understood that the deflectedposition for placement tip (50314) may be defined by the characteristics(e.g., thickness, density, etc.) of the tissue that is being capturedbetween anvil (50318) and lower jaw (50316), thereby causing thedeflection of placement tip (50314). In some variations, placement tip(50314) does not deflect in response to a load.

1. Another Exemplary Surgical Instrument Including Another End Effectorwith Another Example of Placement Tip

FIGS. 83A-83E show enlarged views of a distal end of end effector(50312). Placement tip (50314) is located adjacent at least one ofdistal end (50321) of anvil (50318) or a distal end of lower jaw(50316). As shown in FIGS. 82 and 83A-83E, placement tip (50314) iscoupled with a distal end (50321) of anvil (50318). Placement tip(50314) may be permanently secured to anvil (50318), or alternatively,placement tip (50314) may be removable coupled with anvil (50318).Placement tip (50314) may be integrally formed together with anvil(50318) as unitary piece or consist of separately formed components.Placement tip (50314) may be positioned on the same jaw as staplecartridge (50324) or on the same jaw as anvil (50318). As shown in FIGS.82 and 83A-83E, upper jaw includes anvil (50318), while lower jaw(50316) is removably coupled with staple cartridge (50324). However,this relationship may be reversed if desired. Staple cartridge (50324)is configured to hold one or more staples in a manner similar to staplecartridge (37).

As previously described, at least one of anvil (50318) or lower jaw(50316) is movable relative to other of anvil (50318) or lower jaw(50316) between the open configuration and the closed configuration. Asshown, anvil (50318) pivotably rotates toward lower jaw (50316) in thesame manner as anvil (18) as described above with respect to instrument(10). In this manner, end effector (50312) is like end effector (12),except for the laterally deflected configuration and deformability ofplacement tip (50314). In the closed configuration, a portion ofplacement tip (50314) may in abutting contact with an angled surface(50338) of staple cartridge (50324); or alternatively, a lateral gap mayexist between placement tip (50314) and staple cartridge (50324).Additionally, as shown in the top view of FIGS. 83A-83E, lower jaw(50316) is generally longer and wider than anvil (50318) and placementtip (50314). However, lower jaw (50316) may be shorter and/or andnarrower than anvil (50318) and placement tip (50314) if desired.

FIGS. 82 and 83A-83E show placement tip (50314) as including a proximalportion (50326), a central portion (50328), and a distal portion(50330). Proximal portion (50326) extends distally from distal end(50321) of anvil (50318) and is disposed opposite from lower jaw(50316). Central portion (50328) is disposed longitudinally betweenproximal and distal portions (50326, 50330). Central portion (50328) anddistal portion (50330) of placement tip (50314) each include anasymmetric profile along the longitudinal axis of shaft (50322), i.e.shaft axis (SA50). As shown in the top views of FIGS. 83A-83E, centralportion (50328) tapers inwardly along an inwardly tapering portion(50329) on the left side (when viewed from above), while the oppositeright side extends arcuately toward distal portion (50330).

Distal portion (50330) includes a tip axis (TA50) defined by thedirection to which a tip (50314) of distal portion (50330) extends. Tip(50314) includes a proximal surface (50340) and a distal surface(50342), with proximal surface (50340) extending outwardly from inwardlytapering portion (50329). In the example shown, tip axis (TA50) ismeasured using proximal surface (50340) of tip (50314). Alternatively,other surfaces (e.g. distal surface (50342) may also be used. Moreover,shaft axis (SA50) and tip axis (TA50) define an angle that isselectively adjustable. For improved clarity, a modified shaft axis(SA50′) is respectively shown in FIGS. 83A-83E to better visualize angletheta (θ51-θ55) generally formed between shaft axis (SA50) and tip axis(TA50). A modified shaft axis (SA50′) is offset from and extendsparallel to shaft axis (SA50). Additionally, as shown in FIGS. 83A-83E,tip axis (TA50) is generally perpendicular to the longitudinal axis ofend effector (50312), which is referred herein as end effector axis(EEA50).

As previously described with respect to instrument (10), instrument(50310) is shown as including an articulation joint (50332) thatpivotably couples shaft (50322) with end effector (50312). Articulationjoint (50332) may be the same or similar to articulation joint (11)described above, with details pertaining to articulation joint (50332)being omitted for the sake of brevity. Articulation joint (50332) isconfigured to enable end effector (50312) to pivot laterally relative toshaft (50322). As shown in FIGS. 83A-83E, modified shaft axis (SA50′)and tip axis (TA50) collectively define various angle thetas (θ51-θ55),with angle theta being selectively adjustable using articulation joint(50332). Articulation joint (50332) may be selectively adjustable by auser using powered articulation. Alternatively, articulation joint(50332) may be manually powered using articulation control (50344) shownin FIG. 82. Articulation joint (50332) moves end effector axis (EEA50)relative to shaft axis (SA50), resulting in a different angle theta(θ51-θ55).

As described below in greater detail, FIGS. 83A-83E show various anglethetas (θ51-θ55) that are selectively adjustable between about 0 degreesto about 180 degrees. While FIGS. 83A-83E show angle theta (θ51-θ55) asfive distinct angles, it is to be understood that angle theta may be anyangle in between about 0 degrees to about 180 degrees as well. Forexample, FIG. 83A shows angle theta (θ51) defined by modified shaft axis(SA50′) and tip axis (TA50) being about 0 degrees, such that shaft axis(SA50) and tip axis (TA50) extend generally parallel to one another. Endeffector axis (EEA50) extends approximately perpendicular to both shaftaxis (SA51) and tip axis (TA50), such that angle gamma (γ51) is 90degrees. When angle theta (θ51) is 0 degrees, tip (50314) of distalportion (50330) is directed parallel to the shaft axis (SA50). Tip(50314) is also oriented proximally relative to shaft (50322) in thestate shown in FIG. 83A.

FIG. 83B shows angle theta (θ52) being about 45 degrees and measuredbetween modified shaft axis (SA50′) and tip axis (TA50). Angle gamma(γ52) is about 135 degrees and is measured between shaft axis (SA50) andend effector axis (EEA50).

FIG. 83C shows angle theta (θ53) being about 90 degrees and measuredbetween modified shaft axis (SA50′) and tip axis (TA50). Additionally,angle gamma (γ53) is about 180 degrees measured between shaft axis(SA50) and end effector axis (EEA50).

FIG. 83D shows angle theta (θ54) being about 135 degrees and measuredbetween modified shaft axis (SA50′) and tip axis (TA50). Additionally,angle gamma (γ54) is about 225 degrees measured between shaft axis(SA50) and end effector axis (EEA50).

FIG. 83E shows angle theta (θ55) being about 180 degrees and measuredbetween modified shaft axis (SA50′) and tip axis (TA50). Additionally,angle gamma (γ5) is about 270 degrees measured between shaft axis (SA50)and end effector axis (EEA50). When the angle theta (θ55) is 180degrees, tip (50314) of distal portion (50330) is directed parallel toshaft axis (SA50). Tip (50314) is also oriented distally relative toshaft (50322) in the state shown in FIG. 83E.

Assuming the position of FIG. 83C of end effector (50312) is a baselineposition, like FIG. 82, when tip angle (θ53) is 90 degrees, shaft axis(SA50) is parallel to end effector axis (EEA50). Moreover, assuming FIG.83C is the baseline position, angle theta (θ51-θ52) as shown in FIGS.83A and 83B, forms an acute angle along a first direction ofarticulation (shown as a counter clockwise rotation). Conversely, angletheta (θ54-θ55) as shown in FIGS. 83D and 83E forms an obtuse anglealong a second direction of articulation, that is opposite the firstdirection of articulation (shown as a clockwise rotation).

2. Exemplary Method of Operating Instrument

FIGS. 84A-84D show an exemplary method of operating instrument (50310)for contacting tissue (50410). As shown, instrument (50310) againincludes end effector (50312), placement tip (50314), lower jaw (50316),anvil (50318), shaft (50322), staple cartridge (50324), proximal portion(50326), central portion (50328), distal portion (50330), tip (50314),angled surface (50338), proximal surface (50340), and distal surface(50342). FIG. 84A shows instrument (50310) being introduced towardalready separated first and second layers (50412, 50414) of tissue(50410). First and second layers (50412, 50414) collectively define atissue opening (50416). As shown, instrument (50310) is in the openconfiguration. While not shown, it is also envisioned that upper jaw andlower jaw (50316) may be in the closed configuration. Additionally, theshape of placement tip (50314) may vary if desired.

FIG. 84B shows instrument (50310) being moved laterally toward alreadyseparated first and second layers (50412, 50414) of tissue (50410) thatcollectively define tissue opening (50416). As shown, tip (50314) ofplacement tip (50314) enters an already formed tissue opening (50416).Placement tip (50314) does not perform dissection of tissue (50410),which includes separation of first and second layers (50412, 50414) toform tissue opening (50416). Instead, first and second layers (50412,50414) of tissue (50410) are already separated using any one of avariety of known methods and devices. In some other variations,placement tip (50314) provides at least some blunt dissection of tissue(e.g., separating different anatomical structures apart from each other)as end effector (50312) is moved in the patient.

FIG. 84C shows placement tip (50314) of instrument (50310) movinglaterally through tissue opening (50416). Placing placement tip (50314)through tissue opening (50416) may be obtained using only a lateralmotion in this example. As previously indicated, central portion (50328)and distal portion (50330) have an asymmetric profile along tip axis(TA50) of placement tip (50314). As shown, distal portion (50330) is nowthrough already separated first and second layers of tissue (50412,50414).

FIG. 84D shows placement tip (50314) subsequently advancing (50314)distally once already through tissue opening (50416). According to theperspective view of FIG. 84D, distally is shown as being upwards and tothe left. This of course may vary given the position of tissue (50410).After reaching the state shown in FIG. 84D, the operator may furtherposition end effector (50312) such that tissue (50412) (e.g., a vesseltargeted for transection) is positioned between staple forming pocketsof anvil (50318) and corresponding staple apertures of the staplecartridge. The operator may then actuate end effector (50312) totransect and staple the tissue (50412).

Instrument (50310) according to this example may include articulationjoint (50332) to rotate end effector (50312) to the desired angle, in amanner similar or different to that described above with respect toFIGS. 83A-83E. Laterally moving open jaw of instrument (50310) throughtissue opening (50416) may include the user selectively adjustingarticulation joint (50332) manually or using powered articulation asdescribed previously with respect to instrument (10, 50310).

X. Surgical Stapling End Effector Component with Deformable Tip HavingThick Distal End

A. Another Exemplary Surgical Instrument Having Various End Effectorsand Placement Tips

FIG. 85 shows another exemplary surgical instrument (60310) configuredas a surgical stapler. Instrument (60310) comprises a body, shown as ahandle portion (60320), and a shaft (60322). Shaft (60322) defines alongitudinal axis (LA61) that extends from handle portion (60320).Instrument (60310) has a modular configuration such that shaft (60322)is selectively removable from, and selectively attachable to, handleportion (60320). Instrument (60310) is configured similarly toinstrument (10), such that the operability and use of instrument (60310)is the same as described above for instrument (10) with the addedfeature of instrument (60310) being a modular configuration. With itsmodular configuration, instrument (60310) provides a way to change thedesired end effector. Features operable for providing the modularconfiguration of instrument (60310) may be configured in accordance withat least some of the teachings of U.S. Pub. No. 2017/0086823 entitled“Surgical Stapling Instrument with Shaft Release, Powered Firing, andPowered Articulation,” published Mar. 30, 2017, the disclosure of whichis incorporated by reference herein; and/or U.S. Pat. No. 9,913,642,entitled “Surgical Instrument Comprising a Sensor System,” issued Mar.13, 2018, the disclosure of which is incorporated by reference herein.In some other versions, shaft (60322) is not detachable from handleportion (60320).

As will be discussed in greater detail below, exemplary end effectors(60312, 60412, 60512) are provided on shaft (60322) that is detachablefrom handle portion (60320). End effectors (60312, 60412, 60512) areoperable to compress, staple, and cut tissue. End effectors (60312,60412, 60512) may be used in place of end effector (12) shown in FIG. 1.In some versions, end effectors (60312, 60412, 60512) may be integrallyformed with shaft (60322) or, alternatively, may be separately formedand then combined. In some versions, end effectors (60312, 60412, 60512)may be provided for use in robotic systems. In such robotic systems,modular shaft (60322) having any of the following end effectors (60312,60412, 60512) may be attachable to a portion of the robotic system foruse such that handle portion (60320) is replaced by components of therobotic system, including a body. Other ways to incorporate an endeffector (60312, 60412, 60512) having any of the following placementtips (60314, 60414, 60514) into a user operated or robotic operatedinstrument will be apparent to those of ordinary skill in the art.

As will be described in greater detail below, placement tips (60314,60414, 60514) are configured to be coupled with at least one of an upperjaw (such as anvil 60318, 60418, 60518) or a lower jaw (60316, 416,516). Placement tips (60314, 60414, 60514) may be positioned on the samejaw as staple cartridge (37) or on the same jaw as anvil (60318, 60418,60518). Placement tips (60314, 60414, 60514) are operable to elasticallydeform from a first angled position to a second angled position. Thefirst angled position will be discussed below with respect to eachplacement tip (60314, 60414, 60514). The second angled position forplacement tips (60314, 60414, 60514) may be substantially straight insome versions, but may be angled to a degree (e.g., slightly above orslightly below a longitudinal axis (LA61, LA62, LA63)) in otherversions. The second angled position for placement tips (60314, 60414,60514) may be defined by the characteristics (e.g., thickness, density,etc.) of the tissue that is being captured between anvils (60318, 60418,60518) and lower jaws (60316, 416, 516).

Placement tips (60314, 60414, 60514) described below may be used withany surgical instrument (10, 60310) described above and below and in anyof the various procedures described in the various patent referencescited herein. As will be described in greater detailed below, placementtips (60314, 60414, 60514) may be used singularly or in combination withother placement tips, such as placement tips (60314, 60414, 60514). Tothis end, like numbers below indicate like features described above.Except as otherwise described below, instrument (60310) described belowmay be constructed and operable like instrument (10) described above.Certain details of instrument (60310) will therefore be omitted from thefollowing description, it being understood that such details are alreadyprovided above in the description of instrument (10). Other suitableways in which various surgical instruments may be used will be apparentto those of ordinary skill in the art in view of the teachings herein.

1. Another Exemplary Surgical Instrument Having Another Exemplary EndEffector and Another Example of a Placement Tip

FIGS. 85-90C show end effector (60312) and another exemplary placementtip (60314) of surgical instrument (60310). FIGS. 86-89 show enlargedviews of a distal end of end effector (60312) shown in FIG. 85. Asshown, end effector (60312) includes an upper jaw and a lower jaw(60316). While anvil (60318) is included in an upper jaw, and cartridge(60324) is received in lower jaw (60316), this relationship may bereversed. Staple cartridge (60324) is configured to hold one or morestaples in a manner similar to staple cartridge (37).

At least one of anvil (60318) or lower jaw (60316) is movable relativeto other of anvil (60318) or lower jaw (60316) between an openconfiguration and a closed configuration. As shown, anvil (60318)pivotably rotates toward lower jaw (16) in the same manner as anvil (18)as described above with respect to instrument (10). In this manner, endeffector (60312) is similar to end effector (12), though placement tip(60314) is elastically deformable in this example. Placement tip (60314)obtains a first angled position, shown in FIGS. 86-89, when end effector(60312) is not clamping tissue. More specifically, in this first angledconfiguration, end effector (60312) may be in an open position as shownin FIG. 85, or in a closed position as shown in FIGS. 86-89. Ininstances when end effector (60312) is in this first angledconfiguration, end effector (60312) may be considered in a non-loadedstate or non-loaded position. Conversely, in a second angled position(not shown) when end effector (60312) is clamping tissue, end effector(60312) may be considered in a loaded state or a loaded position. In thesecond angled position, at least a portion of placement tip (60314)deflects upwardly.

Placement tip (60314) is located adjacent at least one of distal end(60321) of anvil (60318) or a distal end of lower jaw (60316). As shownin FIGS. 86-89, placement tip (60314) is coupled with a distal end(60321) of anvil (60318). Additionally, as shown in the top view of FIG.88, lower jaw (60316) is longer and wider than anvil (60318) andplacement tip (60314). However, lower jaw (60316) may be shorter and/orand narrower than anvil (60318) and placement tip (60314), if desired.

FIGS. 86, 88 and 89 each show placement tip (60314) as including aproximal portion (60326), a central portion (60328), and a distalportion (60330). Proximal portion (60326) extends distally from anvil(60318). Central portion (60328) is disposed longitudinally betweenproximal and distal portions (60326, 60330). Additionally, as shown inFIG. 88, placement tip (60314) is symmetric about a longitudinal axis(LA61). However, placement tip (60314) may be non-symmetric, if desired.Placement tip (60314) may be integrally formed together as unitary pieceor consist of separately formed components.

FIG. 88 shows placement tip (60314) having a generally uniform widthalong the entire length of placement tip (60314) along longitudinal axis(LA61). In other words, the width of the transverse cross-section ofplacement tip (60314) is generally uniform. Distal portion (60330) ofplacement tip (60314) has a distal tip width (DTW1) that is greater thana distal jaw width (DJW61) of lower jaw (60316) disposed oppositeplacement tip (60314). However, this is not as pronounced as theexamples shown in FIGS. 93 and 96. Proximal portion (60326) of placementtip (60314) has a proximal tip width (PTW61) that is less than aproximal jaw width (PJW61) of lower jaw (60316) that is disposedopposite placement tip (60314). Since placement tip (60314) has agenerally uniform width, proximal tip width (PTW61) is generally equalto distal tip width (DTW61). Additionally, as shown in FIG. 88, lowerjaw (60316) extends distally a distance (D61) beyond a distal tip ofplacement tip (60314).

FIG. 89 shows placement tip (60314) as including an angled planar uppersurface (60332) abutting a planar distal surface (60334). As shown,distal portion (60330) terminates at planar distal surface (60334) thatextends perpendicular to longitudinal axis (LA61) and parallel totransverse cross-section, for example, line 90A-90A, line 90B-90B, orline 90C-90C. Additionally, regarding the closed configuration, FIG. 89shows a contacting portion (60336) that is in abutting contact with anangled surface (60338) of staple cartridge (60324). With continuedreference to FIG. 89, placement tip (60314) includes an angled undersidesurface (60340), a top arcuate surface (60342), and a proximal undersidesurface (60344). FIG. 89 also shows distal portion (60330) including adistal underside surface (60346) that is non-parallel to angledunderside surface (60340).

Regarding the angles shown in FIG. 89, a first angle alpha (α61) isdefined between angled surface (60338) of staple cartridge and angledunderside surface (60340) of placement tip (60314). Similarly, a firstangle beta (β61) is defined between angled surface (60338) and angledplanar upper surface (60332). Since angled surface (60338) and angledplanar upper surface (60332) appear generally parallel, first angle beta(β61) is small.

As shown in the side view of FIG. 89 and the cross-sectional views ofFIGS. 90A-90C, the thickness of placement tip (60314) varieslongitudinally along longitudinal axis (LA61). More specifically, FIG.90A shows a cross-sectional view of proximal portion (60326) ofplacement tip (60314) of FIG. 89, taken along line 90A-90A of FIG. 89having a proximal cross-sectional thickness (PTT61). As shown in FIG.89, proximal cross-sectional thickness (PTT61) of placement tip (60314)is generally uniform. Proximal cross-sectional thickness (PTT61) may beassessed at a location where placement tip (60314) attaches to anvil(60318).

FIG. 90B shows a cross-sectional view of a central portion (60328) ofplacement tip (60314) of FIG. 89, taken along line 90B-90B of FIG. 89having a central cross-sectional thickness (CTT61). As shown, centralcross-sectional thickness (CTT61) taken along transverse cross-sectionis less than proximal cross-sectional thickness (PTT61).

FIG. 90C shows a cross-sectional view of distal portion (60330) ofplacement tip (60314) of FIG. 89, taken along line 90C-90C of FIG. 89having a distal cross-sectional thickness (DTT61). As shown, distalcross-sectional thickness (DTT61) taken along a transverse cross-sectionis greater than proximal cross-sectional thickness (PTT61) of proximalportion (60326) along the transverse cross-section which is greater thancentral cross-sectional thickness (CTT61) of central portion (60328)along the transverse cross-section.

2. Another Exemplary Surgical Instrument Having Another Exemplary EndEffector and Another Example of a Placement Tip

FIGS. 91-95C show another exemplary end effector (60412) includinganother exemplary placement tip (60414). As shown in FIGS. 91-94, endeffector (60412) of the present example comprises placement tip (60414),a lower jaw (60416), an anvil (60418), a distal end (60421) of anvil(60418), a shaft (60422), a staple cartridge (60424), a proximal portion(60426), a central portion (60428), a distal portion (60430), an angledupper surface (60432), a planar perpendicular distal surface (60434), acontacting portion (60436), an angled surface (60438) of staplecartridge (60424), an angled underside surface (60440), a top arcuatesurface (60442), and a proximal underside surface (60444).

FIGS. 91, 93, and 94 each show placement tip (60414) as includingproximal portion (60426), central portion (60428), and distal portion(60430). Proximal portion (60426) extends distally from and is attachedto anvil (60418). As previously discussed, it is also envisioned thatplacement tip (60414) may be integrally formed with one of anvil (60418)or lower jaw (60416). Central portion (60428) is disposed longitudinallybetween proximal and distal portions (60426, 60330). Additionally, asshown in FIG. 93, placement tip (60414) is symmetric about alongitudinal axis (LA62). However, placement tip (60414) may benon-symmetric, if desired. Placement tip (60414) may be integrallyformed together as unitary piece or consist of separately formedcomponents.

FIG. 93 shows placement tip (60414) having a generally uniform widthalong the entire length of placement tip (60414) along longitudinal axis(LA62). In other words, the width of the transverse cross-section ofplacement tip (60414) is generally uniform. Distal portion (60430) ofplacement tip (60414) has a distal tip width (DTW62) that is greaterthan a distal jaw width (DJW62) of lower jaw (60416) disposed oppositeplacement tip (60414). As such, placement tip (60414) includes first andsecond overhang portions (60431, 433) that extend beyond lower jaw(60416). Proximal portion (60426) of placement tip (60414) has aproximal tip width (PTW62) that is less than a proximal jaw width(PJW62) of lower jaw (60416) that is disposed opposite placement tip(60414). Since placement tip (60414) has a generally uniform width,proximal tip width (PTW62) is generally equal to distal tip width(DTW62). Additionally, as shown in FIG. 93, lower jaw (60416) extendsdistally a distance (D62) beyond a distal tip of placement tip (60414).

FIG. 94 shows placement tip (60414) as including an angled planar uppersurface (60432) and a planar distal surface (60434). As shown, distalportion (60430) terminates at planar distal surface (60434) that extendsperpendicular to longitudinal axis (LA62) and parallel to transversecross-section, for example, shown as line 95A-95A, line 95B-95B, or line95C-95C. With continued reference to FIG. 94, placement tip (60414)includes an angled underside surface (60440), a top arcuate surface(60442), and a proximal underside surface (60444). Unlike placement tip(60314) shown in FIG. 94, angled underside surface (60440) of placementtip (60414) extends completely to planar distal surface (60434), and asa result, placement tip (60414) omits a separately angled distalunderside surface. Additionally, regarding the closed configuration,FIG. 94 shows a contacting portion (60436) that is in abutting contactwith an angled surface (60438) of staple cartridge (60424).

Regarding the angles shown in FIG. 94, a second angle alpha (α62) isdefined between angled surface (60438) of staple cartridge and angledunderside surface (60440). Since angled surface (60438) of staplecartridge and angled underside surface (60440) appear generallyparallel, second angle beta (β62) is small. Similarly, a second anglebeta (β62) is defined between angled surface (60438) and angled planarupper surface (60432).

As shown in the side view of FIG. 94 and the cross-sectional views ofFIGS. 95A-95C, the thickness of placement tip (60414) varieslongitudinally along the longitudinal axis (LA62). More specifically,FIG. 95A shows a cross-sectional view of proximal portion (60426) ofplacement tip (60414) of FIG. 94, taken along line 95A-95A of FIG. 94having a proximal cross-sectional thickness (PTT62). As shown in FIG.94, proximal cross-sectional thickness (PTT62) of placement tip (60414)is generally uniform. Proximal cross-sectional thickness (PTT62) may beassessed at a location where placement tip (60414) attaches to anvil(60418).

FIG. 95B shows a cross-sectional view of central portion (60428) ofplacement tip (60414) of FIG. 94, taken along line 95B-95B of FIG. 94having a central cross-sectional thickness (CTT62). FIG. 95C shows across-sectional view of distal portion (60430) of placement tip (60414)of FIG. 94, taken along line 95C-95C of FIG. 94 having a distalcross-sectional thickness (DTT62). As shown, central cross-sectionalthickness (CTT62) of central portion (60428) taken along the transversecross-section is greater than distal cross-sectional thickness (DTT62)of distal portion (60430) along the transverse cross-section which isgreater than proximal cross-sectional thickness (PTT62) of proximalportion (60426) along the transverse cross-section.

3. Another Exemplary Surgical Instrument Having an Exemplary EndEffector and an Example of a Placement Tip

FIGS. 96-98C show another exemplary end effector (60512) includinganother exemplary placement tip (60514). As shown in FIGS. 96 and 97,end effector (60512) of the present example comprises another exemplaryplacement tip (60514), a lower jaw (60516), an anvil (60518), a distalend (60521) of anvil (60518), a shaft (60522), a staple cartridge(60524), a proximal portion (60526), a central portion (60528), a distalportion (60530), an angled upper surface (60532), a planar perpendiculardistal surface (60534), a contacting portion (60536), an angled surface(60538) of staple cartridge (60524), an angled underside surface(60540), a top arcuate surface (60542), and a proximal underside surface(60544).

FIGS. 96 and 97 each show placement tip (60514) as including proximalportion (60526), central portion (60528), and distal portion (60530).Proximal portion (60526) extends distally from anvil (60518). Centralportion (60528) is disposed longitudinally between proximal and distalportions (60526, 60330). Additionally, as shown in FIG. 96, placementtip (60514) is symmetric about a longitudinal axis (LA63). However,placement tip (60514) may be non-symmetric, if desired. Placement tip(60514) may be integrally formed together as unitary piece or consist ofseparately formed components.

FIG. 96 shows placement tip (60514) having a generally uniform widthalong the entire length of placement tip (60514) along longitudinal axis(LA63). In other words, the width of the transverse cross-section ofplacement tip (60514) is generally uniform. Distal portion (60530) ofplacement tip (60514) has a distal tip width (DTW63) that is greaterthan a distal jaw width (DJW63) of lower jaw (60516) disposed oppositeplacement tip (60514). As such, placement tip (60514) includes first andsecond overhang portions (60531, 533) that extend beyond lower jaw(60516). Proximal portion (60526) of placement tip (60514) has aproximal tip width (PTW36) that is less than a proximal jaw width(PJW63) of lower jaw (60516) that is disposed opposite placement tip(60514). Since placement tip (60514) has a generally uniform width,proximal tip width (PTW63) is generally equal to distal tip width(DTW63). Additionally, as shown in FIG. 96, lower jaw (60516) extendsdistally a distance (D63) beyond a distal tip of placement tip (60514).

FIG. 97 shows distal portion (60530) of placement tip (60514)terminating at planar distal surface (60534) that extends perpendicularto longitudinal axis (LA63) and parallel to transverse cross-section,for example, shown by line 98A-98A, line 98B-98B, or line 98C-98C.Unlike placement tip (60314) shown in FIG. 97, angled underside surface(60540) of placement tip (60514) extends completely to planar distalsurface (60534), and as a result, placement tip (60514) omits aseparately angled distal underside surface. Additionally, regarding theclosed configuration, FIG. 97 shows contacting portion (60536) inabutting contact with angled surface (60538) of staple cartridge(60524).

Regarding the angles shown in FIG. 97, a third angle alpha (α63) isdefined between angled surface (60538) of staple cartridge and angledunderside surface (60540) defines. Similarly, a third angle beta (β63)is defined between angled surface (60538) and angled planar uppersurface (60532) defines. Since angled surface (60538) and angled planarupper surface (60532) appear generally parallel, third angle beta (β63)is small.

As shown in the side view of FIG. 97 and the cross-sectional views ofFIGS. 98A-98C, the thickness of placement tip (60514) varieslongitudinally along the longitudinal axis (LA63). More specifically,FIG. 98A shows a cross-sectional view of proximal portion (60526) ofplacement tip (60514) of FIG. 97, taken along line 98A-98A of FIG. 97having a proximal cross-sectional thickness (PTT63). As shown in FIG.97, proximal cross-sectional thickness (PTT63) of placement tip (60514)is generally uniform. Proximal cross-sectional thickness (PTT63) may beassessed at a location where proximal portion (60526) of placement tip(60514) attaches to anvil (60518).

FIG. 98B shows a cross-sectional view of central portion (60528) ofplacement tip (60514) of FIG. 94, taken along line 98B-98B of FIG. 97having a central cross-sectional thickness (CTT63). Similarly, FIG. 98Cshows a cross-sectional view of distal portion (60530) of placement tip(60514) of FIG. 97, taken along line 98C-98C of FIG. 97 having a distalcross-sectional thickness (DTT63). The thickness of placement tip(60514) continually increases moving distally along the entire length ofplacement tip (60514). For example, proximal cross-sectional thickness(PTT63) of proximal portion (60526) is less than central cross-sectionalthickness (CTT63) of central portion (60528) which is less than distalcross-sectional thickness (DTT63) of distal portion (60530).

XI. Buttress Applier Cartridge for Surgical Stapler Having End Effectorwith Deflectable Curved Tip

A. Another Exemplary Surgical Instrument Including End Effector withAnother Placement Tip

FIG. 99 shows another exemplary instrument (70310) with anotherexemplary end effector (70312) and another exemplary placement tip(70314). Instrument (70310) may have a modular configuration such thatshaft (70322) is selectively removable from, and selectively attachableto, handle portion (70320). Instrument (70310) is configured similarlyto instrument (10), such that the operability and use of instrument(70310) is the same as described above for instrument (10) with theadded feature of instrument (70310) having a modular configuration. Withits modular configuration, instrument (70310) provides a way to changethe desired end effector. Features operable for providing the modularconfiguration of instrument (70310) may be configured in accordance withat least some of the teachings of U.S. Pub. No. 2017/0086823 entitled“Surgical Stapling Instrument with Shaft Release, Powered Firing, andPowered Articulation,” published Mar. 30, 2017, the disclosure of whichis incorporated by reference herein; and/or U.S. Pat. No. 9,913,642,entitled “Surgical Instrument Comprising a Sensor System,” issued Mar.13, 2018, the disclosure of which is incorporated by reference herein.In some other versions, shaft (70322) is not detachable from handleportion (70320).

End effector (70312) is provided on shaft (70322) that is detachablefrom handle portion (70320). End effector (70312) is operable tocompress, staple, and cut tissue. End effector (70312) may be used inplace of end effector (12) shown in FIG. 1. In some versions, endeffector (70312) may be integrally formed with shaft (70322) or,alternatively, may be separately formed and subsequently combined. Insome versions, end effector (70312) may be provided for use in roboticsystems. In such robotic systems, modular shaft (70322) having any ofthe following end effector (70312) may be attachable to a portion of therobotic system for use such that handle portion (70320) is replaced bycomponents of the robotic system, including a body. Other ways toincorporate end effector (70312) having any of the following placementtips (70314) into a user operated or robotic operated instrument will beapparent to those of ordinary skill in the art.

Placement tip (70314) is operable to elastically deform from anon-deflected position to a deflected position. Placement tip (70314)obtains the non-deflected position when end effector (70312) is notclamping tissue. More specifically, in this non-deflected position, endeffector (70312) may be in the open configuration as shown in FIG. 99,or in the closed configuration as shown in FIGS. 8 and 9 with respect toend effector (212). In instances when end effector (70312) are in thisnon-deflected position, end effector (70312) may be considered in anon-loaded state or non-loaded position. Conversely, in the deflectedposition (not shown) when end effector (70312) is clamping tissue, endeffector (70312) may be considered in a loaded state or a loadedposition. In the deflected position, at least a portion of placement tip(70314) deflect upwardly. The deflected position for placement tip(70314) may be substantially straight in some versions, but may bedeflected to a degree (e.g., slightly above or slightly belowlongitudinal (LA71)) in other versions. It should be understood that thedeflected position for placement tip (70314) may be defined by thecharacteristics (e.g., thickness, density, etc.) of the tissue that isbeing captured between respective lower jaw (70316) and anvil (70318),thereby causing the deflection of placement tip (70314). In somevariations, placement tip (70314) does not deflect in response to aload.

FIG. 99 shows surgical instrument (70310), configured as a surgicalstapler, that comprises another exemplary end effector (70312) andanother exemplary placement tip (70314). End effector (70312) includesan upper jaw and a lower jaw (70316), with the upper jaw including ananvil (70318). Instrument (70310) additionally includes a body, shown asa handle portion (70320), and a shaft (70322) that extends from handleportion (70320). As shown in FIG. 99, shaft (70322) defines alongitudinal axis (LA71) that is colinear with an end effector axis(EEA71) of end effector (70312), but which may non-colinear, and insteadangled, when end effector (70312) is articulated relative to shaft(70322) using articulation joint (70323).

Placement tip (70314) is located adjacent at least one of a distal end(70321) of anvil (70318) or a distal end of lower jaw (70316). As shownin FIG. 99, placement tip (70314) is coupled with distal end (70321) ofanvil (70318). Placement tip (70314) may be permanently coupled withanvil (70318), or alternatively, placement tip (70314) may be removablycoupled with anvil (70318). Placement tip (70314) may be integrallyformed together with anvil (70318) as unitary piece or consist ofseparately formed components. Placement tip (70314) may be positioned onthe same jaw as staple cartridge (70324) or on the same jaw as anvil(70318). As shown in FIG. 99, upper jaw includes anvil (70318), whilelower jaw (70316) is removably coupled with staple cartridge (70324).However, this relationship may be reversed if desired. Staple cartridge(70324) is configured to hold one or more staples in a manner similar tostaple cartridge (37). Staple cartridge includes an angled distalportion (70326). As previously described, at least one of anvil (70318)or lower jaw (70316) is movable relative to other of anvil (70318) orlower jaw (70316) between the open configuration and the closedconfiguration. As shown, anvil (70318) pivotably rotates toward lowerjaw (70316) in the same manner as anvil (18) as described above withrespect to instrument (10). In this manner, end effector (70312) is likeend effector (12), except for the laterally deflected configuration anddeformability of placement tip (70314).

B. Exemplary Buttress Assembly for Surgical Stapler

In some instances, it may be desirable to equip end effectors (12, 212,70312) with a buttress material to reinforce the mechanical fastening oftissue provided by staples (47). Such a buttress may prevent the appliedstaples (47) from pulling through the tissue and may otherwise reduce arisk of tissue tearing at or near the site of applied staples (47). Inaddition to or as an alternative to providing structural support andintegrity to a line of staples (47), a buttress may provide variousother kinds of effects such as spacing or gap-filling, administration oftherapeutic agents, and/or other effects. In some instances, a buttressmay be provided on upper deck (72) of staple cartridge (37). Asdescribed above, deck (72) houses staples (47), which are driven bystaple driver (7043). In some other instances, a buttress may beprovided on the surface of anvil (18, 218, 70318) that faces staplecartridge (37, 237, 70324). It should also be understood that a firstbuttress may be provided on upper deck (72) of staple cartridge (37,237, 70324) while a second buttress is provided on anvil (18, 218,70318) of the same end effector (12, 212). Various examples of formsthat a buttress may take will be described in greater detail below.Various ways in which a buttress may be secured to a staple cartridge(37, 237, 70324) or an anvil (18, 218, 70318) will also be described ingreater detail below. Exemplary buttress assemblies, exemplary materialsand techniques for applying buttress assemblies, and exemplary buttressapplier cartridges may be configured in accordance with at least some ofthe teachings of U.S. Pub. No. 2017/0055981 entitled “Method of Applyinga Buttress to a Surgical Stapler End Effector,” published Mar. 2, 2017,the disclosure of which is incorporated by reference herein.

1. Exemplary Composition of Buttress Assembly for Surgical Stapler

FIG. 100 shows an exemplary pair of buttress assemblies (70410, 70412)with a basic composition. Buttress assembly (70410) of this examplecomprises a buttress body (70414) and an upper adhesive layer (70416).Similarly, buttress assembly (70412) comprises a buttress body (70418)and a lower adhesive layer (70420). In the present example, eachbuttress body (70414, 70418) comprises a strong yet flexible materialconfigured to structurally support a line of staples (70447). By way ofexample only, each buttress body (70414, 70418) may comprise a mesh ofpolyglactin 910 material by Ethicon, Inc. of Somerville, N.J.Alternatively, any other suitable materials or combinations of materialsmay be used in addition to or as an alternative to polyglactin 910material to form each buttress body (70414, 70418).

Each buttress body (70414, 70418) may comprise a material including, forexample, a hemostatic agent such as fibrin to assist in coagulatingblood and reduce bleeding at the severed and/or stapled surgical sitealong tissue (T₇₁, T₇₂). As another merely illustrative example, eachbuttress body (70414, 70418) may comprise other adjuncts or hemostaticagents such as thrombin may be used such that each buttress body (70414,70418) may assist to coagulate blood and reduce the amount of bleedingat the surgical site. Other adjuncts or reagents that may beincorporated into each buttress body (70414, 70418) may further includebut are not limited to medical fluid or matrix components. Merelyillustrative examples of materials that may be used to form eachbuttress body (70414, 70418), as well as materials that may be otherwiseincorporated into each buttress body (70414, 70418), are disclosed inU.S. Pub. No. 2016/0278774, entitled “Method of Applying a Buttress to aSurgical Stapler,” published Sep. 29, 2016, the disclosure of which isincorporated by reference herein. Alternatively, any other suitablematerials may be used.

In the present example, adhesive layer (70416) is provided on buttressbody (70414) to adhere buttress body (70414) to underside (70424) ofanvil (18). Similarly, adhesive layer (70420) is provided on buttressbody (70418) to adhere buttress body (70418) to upper deck (72) ofstaple cartridge (37). Such an adhesive material may provide properpositioning of buttress body (70414, 70418) before and during actuationof end effector (12); then allow buttress body (70414, 70418) toseparate from end effector (12) after end effector (12) has beenactuated, without causing damage to buttress body (70414, 70418) that issubstantial enough to compromise the proper subsequent functioning ofbuttress body (70414, 70418). Examples of various suitable materialsthat may be used to form adhesive layers (70416, 70420) are disclosed inU.S. Pub. No. 2016/0278774, the disclosure of which is incorporated byreference herein.

2. Exemplary Materials and Techniques for Providing Adhesion of Buttressto Surgical Stapler

FIGS. 101A-101C show a sequence where an end effector (12) that has beenloaded with buttress assemblies (70410, 70412) is actuated to drivestaples (47) through two opposed layers of tissue (T₇₁, T₇₂), withbuttress assemblies (70410, 70412) being secured to the same layers oftissue (T₇₁, T₇₂) by staples (47). In particular, FIG. 101A shows layersof tissue (T₇₁, T₇₂) positioned between anvil (18) and staple cartridge(37), with anvil (18) in the open position. Buttress assembly (70410) isadhered to underside (70424) of anvil (18) via adhesive layer (70416);while buttress assembly (70412) is adhered to upper deck (72) of staplecartridge (37) via adhesive layer (70420). Layers of tissue (T₇₁, T₇₂)are thus interposed between buttress assemblies (70410, 70412). Next,closure trigger (26) is pivoted toward pistol grip (24) to drive closuretube (7032) and closure ring (7033) distally. This drives anvil (18) tothe closed position as shown in FIG. 101B. At this stage, layers oftissue (T₇₁, T₇₂) are compressed between anvil (18) and staple cartridge(37), with buttress assemblies (70410, 70412) engaging opposite surfacesof tissue layers (T₇₁, T₇₂). End effector (12) is then actuated asdescribed above, driving staple (47) through buttress assemblies (70410,70412) and tissue (T₇₁, T₇₂). As shown in FIG. 101C, crown (70422) ofdriven staple (47) captures and retains buttress assembly (70412)against layer of tissue (T₇₂). Deformed legs (70426) of staple (47)capture and retain buttress assembly (70410) against layer of tissue(T₇₁).

A series of staples (47) will similarly capture and retain buttressassemblies (70410, 70412) against layers of tissue (T₇₁, T₇₂), therebysecuring buttress assemblies (70410, 70412) to tissue (T₇₁, T₇₂) asshown in FIG. 102. As end effector (12) is pulled away from tissue (T₇₁,T₇₂) after deploying staples (47) and buttress assemblies (70410,70412), buttress assemblies (70410, 70412) disengage end effector), suchthat buttress assemblies (70410, 70412) remain secured to tissue (T₇₁,T₇₂) with staples (47). Buttress tissue (T₇₁, T₇₂) thus providestructural reinforcement to the lines of staples (47). As can also beseen in FIG. 102, distally presented cutting edge (7048) of firing beam(14) also cuts through a centerline of buttress tissue assemblies(70410, 70412), separating each buttress assemblies (70410, 70412) intoa corresponding pair of sections, such that each section remains securedto a respective severed region of tissue (T₇₁, T₇₂).

3. Exemplary Buttress Applier Cartridge with Active Retainer Arms

Because end effector (12) may be actuated many times during use ofinstrument (10) in a single surgical procedure, it may be desirable toenable an operator to repeatedly and easily load buttress assemblies(70410) on underside (70424) of anvil (18) during that single surgicalprocedure. FIGS. 103-105B show an exemplary buttress applier cartridge(70510) that may be used to support and protect buttress assemblies(70410, 70412). Cartridge (70510) may also be used to easily loadbuttress assemblies (70410, 70412) on end effector (12). As best seen inFIGS. 103-104, cartridge (70510) of this example comprises an open end(70512) and a closed end (70514). Open end (70512) is configured toreceive end effector (12) as will be described in greater detail below.Cartridge (70510) further includes a first housing (70516 a) and asecond housing (70516 b), which each generally define a “U” shape topresent open end (70512). A platform (70518) and a sled retainer (70520)are interposed between first and second housings (70516 a-b).

Platform (70518) of the present example is configured to support a pairof buttress assemblies (70410) on one side of platform (70518) andanother pair of buttress assemblies (70412) on the other side ofplatform (70518). Platform (70518) is exposed in recesses that areformed between the prongs of the “U” configuration of first and secondhousings (70516 a-b). Each buttress assembly (70410, 70412) is providedin a respective pair of portions that are separated to avoid spanningacross slots (42, 49) of anvil (18) and staple cartridge (37),respectively, though platform (70518) may just as easily support wideversions of buttress assemblies (70410, 70412) that unitarily spanacross slots (42, 49) of anvil (18) and staple cartridge (37),respectively. More specifically, the outer edges of platform (70518)include retention features (70530) in the form of ridges that furtherengage first and second housings (70516 a-b) to prevent platform (70518)from sliding relative to first and second housings (70516 a-b).

First and second housings (70516 a-b) include integral gripping features(70522) that have a surface geometry that is configured to promote anoperator's grip of cartridge (70510) during use of cartridge (70510).Indicator plates (70524) are positioned to correspond with windows(70526) that are formed in first and second housings (70516 a-b), suchthat indicator plates (70524) are visible through windows (70526) atdifferent times. Arms (70528) of the present example are configured toselectively secure buttress assemblies (70410, 70412) to platform(70518). In the present example, arms (70528) are resilient and are thusconfigured to resiliently bear against buttress assemblies (70410,70412), thereby pinching buttress assemblies (70410, 70412) againstplatform (70518). Buttress applier cartridge (70510) includes a taperedcam surface (70532) and a housing engagement feature (70534). As bestseen in FIG. 104, housing engagement features (70534) are positioned toengage corresponding surfaces of first and second housings (70516 a-b).As shown in FIGS. 103-104, first and second housings (70516 a-b) includeproximal guide features (70536) and distal guide features (70538). Guidefeatures (70536, 70538) are configured to assist in providing properalignment of end effector (40) with cartridge (70510). In the presentexample, guide features (70536, 70538) are unitarily formed features offirst and second housings (70516 a-b).

FIG. 105A shows cartridge (70510) in a configuration where retainer arms(70528) are positioned to hold buttress assemblies (70410, 70412)against platform (70518); while FIG. 105B shows cartridge (70510) in aconfiguration where retainer arms (70528) are positioned to releasebuttress assemblies (70410, 70412) from platform (70518). While FIGS.105A-105B only show buttress assembly (70410) on platform (70518),buttress assembly (70412) would be retained on and released fromplatform (70518) in an identical fashion. To use cartridge (70510) toload end effector (12), the operator would first position cartridge(70510) and end effector (12) such that end effector is aligned withopen end (70512) of cartridge (70510) as shown in FIG. 105A. Theoperator would then advance end effector (12) distally (and/or retractcartridge (70510) proximally) to position platform (70518) and buttressassemblies (70410, 70412) between anvil (18) and staple cartridge (37)as shown in FIG. 105B. This will ultimately result in the arrangementshown in FIG. 105A.

C. Exemplary Buttress Applier Cartridges

It may be desirable to use buttress assemblies (70410, 70412) with endeffector (212, 70312). However, since end effectors (212, 70312) havecurved distal tips (219, 70314), it may be difficult or impractical touse cartridge (70510) to load buttress assemblies (70410, 70412) on endeffectors (212, 70312). It may therefore be desirable to provide amodified version of cartridge (70510) that accommodates curved distaltips (219, 70314), thereby facilitating loading of buttress assemblies(70410, 70412) on end effectors (212, 70312). Examples of such abuttress applier cartridge (70610, 70710) are described below. Whilebuttress applier cartridges (70610, 70710) are described in the contextof end effector (70312), buttress applier cartridges (70610, 70710) mayalso be used with end effector (212) and other end effectors that havecurved or otherwise deflected distal tip portions.

1. Another Exemplary Buttress Applier Cartridge

FIGS. 106-108B show another exemplary buttress applier cartridge (70610)that may be used to support and protect buttress assemblies (70410,70412). Buttress applier cartridge (70610) may also be used to easilyload buttress assemblies (70410, 70412) on end effector (70312). Asshown in FIG. 106, buttress applier cartridge (70610) includes an openend (70612) and a closed end (70614). Open end (70612) is configured toreceive end effector (70312), in a similar manner as buttress appliercartridge (70510) shown in FIGS. 105A-105B. While buttress appliercartridge (70610) is described and shown below with relation toinstrument (70310), end effector (70312), placement tip (70314), lowerjaw (70316), anvil (70318) and staple cartridge (70324), principles arealso applicable to other instruments have curved distal tips, such asend effector (212) that includes lower jaw (216), anvil (218), distaltip (219) and staple cartridge (37).

With continued reference to FIG. 106, buttress applier cartridge (70610)includes a first housing (70616 a) and a second housing (70616 b), witheach generally defining a “U” shape to present open end (70612). Firstand second housings (70616 a-b) define a gap (G70) configured to receivea portion of an end effector (70312) of a surgical stapler (70310).First and second housings (70616 a-b) receive a platform (70618). Firsthousing (70616 a) includes proximal and distal portions (70620 a, 70622a), while second housing (70616 b) includes proximal and distal portions(70620 b, 70622 b). As shown, first and second housings (70616 a-b) areseparately formed from platform (70618) and subsequently coupled withplatform (70618). Alternatively, first and second housings (70616 a-b)may be integrally formed together as a unitary piece together andsubsequently coupled with platform (70618), or alternatively, first andsecond housings (70616 a-b) may be integrally formed together as aunitary piece together with platform (70618). As shown, first and secondhousings (70616 a-b) and platform (70618) are symmetric about a planegenerally defined by platform (70618). In other words, using the spatialorientation of FIG. 107, the left side of the buttress applier cartridge(70610) is symmetric to the right side of the buttress applier cartridge(70610). Similarly, using the spatial orientation of FIG. 108A-108Bshowing distal portions (70622 a-b, 70630), the top side of the buttressapplier cartridge (70610) is symmetric to the bottom side of thebuttress applier cartridge (70610). The buttress applier cartridge(70610) may be non-symmetric if desired.

Platform (70618) is configured to support one or more buttressassemblies (70400, 70410) against a first side (70624) (e.g. a top side)of platform (70618) and one or more buttress assemblies (70412) againsta second side (70626) (e.g. a bottom side) of platform (70618). Asshown, platform (70618) includes proximal and distal portions (70628,70630). Platform (70618) is disposed between first and second housings(70616 a-b). A portion of platform (70618) is disposed within gap (G70)defined by first and second housings (70616 a-b). The location ofplatform (70618) and buttress assemblies (70410, 70412) in the gap (G70)may prevent inadvertent contact between buttress assemblies (70410,70412) and other devices in the operating room. In other words, firstand second housings (70616 a-b) may provide some degree of physicalshielding of buttress assemblies (70410, 70412). Outer portions ofplatform (70618) may be captured between first and second housings(70616 a-b) to thereby securably couple platform (70618) with first andsecond housings (70616 a-b).

In some versions, platform (70618) is formed of a material that providesa high coefficient of friction, thereby reducing any tendency thatbuttress assemblies (70410, 70412) might otherwise have to slide alongcorresponding surfaces of platform (70618). For instance, platform(70618) may comprise an elastomeric material and/or a foam material. Insome instances, platform (70618) is formed of a compressible foammaterial that is configured to maintain a compressed configuration afterbeing compressed by end effector (70312). By way of example only,platform (70618) may comprise Santoprene, closed-cell polyurethane foam,any other compressible material, and/or a material that may be madecompressible via geometry (e.g., a rubber material with deformablestanding features). Various suitable materials and structuralconfigurations that may be used to form platform (70618) will beapparent to those of ordinary skill in the art in view of the teachingsherein.

At least one of distal portion (70630) of platform (70618) or distalportion (70622 a-b) of first and second housings (70616 a-b) include oneor more cavities configured to receive a curved distal tip (70314) of afirst jaw of end effector (70312). As shown in FIGS. 106-108B, firsthousing (70616 a) includes a first cavity (70632) disposed adjacentfirst side (70624) of platform (70618). First cavity (70632) enablescurved distal tip (70314) to extend below a staple deck (such as stapledeck (72) of staple cartridge (37)) in the closed configuration. Firstcavity (70632) terminates at a top surface of platform (70618). Asshown, first cavity (70632) extends generally perpendicular to platform(70618). However, first cavity (70632) may extend at various suitableangles relative to platform (70618). As shown, first cavity (70632) hasa cross-sectional area that increases moving towards platform (70618).First cavity (70632) has an inner perimeter (IP70) defined by innerwalls (70634) that is configured to closely accommodate an outerperimeter (0P70) of curved distal tip (70314) of end effector (70312).As shown, first cavity (70632) does not extend across the entire widthof gap (G70); however, first cavity (70632) may extend across the entirewidth of gap (G70) if desired. As shown in FIG. 108B, curved distal tip(70314) of end effector (70312) is configured to deform against platform(70618) when end effector (70312) is in the closed configuration.

Since buttress applier cartridge (70610) is shown as being symmetric, asecond cavity (70636) having inner walls (70638) is adjacent second side(70626) of platform (70618). As shown in FIG. 107, second cavity (70636)terminates at second side (70626) of platform (70618). Since first andsecond cavities (70632, 70636) have inner perimeter (IP70) configured toreceive outer perimeter (OP70) of placement tip (70314), the particularshapes and sizes of first and second cavities (70632, 70636) may vary tocorrespond with the desired placement tip (70314). As such, it isenvisioned that second cavity (70636) may be sized and shaped similar tofirst cavity (70632), or alternatively, may be sized and/or shapeddifferently than first cavity (70632), such that second cavity (70636)is configured to receive a different placement tip than first cavity(70632) if desired.

At least one of distal portion (70630) of platform (70618) or distalportion (70622 a-b) of housings (70616 a-b) include a surface configuredto assist in placement of a staple cartridge (70324) of a second jaw ofend effector (70312). As shown in FIGS. 107-108B, second housing (70616b) includes a first angled surface (70640) formed on an opposing side offirst cavity (70632). First angled surface (70640) extends across gap(G70) adjacent second side (70626) of platform (70618). First angledsurface (70640) is configured to assist in placement of a second jaw ofend effector (212, 70312) adjacent second side (70626) of platform(70618). More specifically, first angled surface (70640) is configuredto assist in placement of staple cartridge (37, 70324). As shown,placement tip (70314) is coupled with anvil (70318) is disposed oppositelower jaw (70316) this is configured to receive staple cartridge(70324). First angled surface (70640) is in abutting contact with adistal angled portion (70326) of staple cartridge (37, 70337) when theopposing jaws (such as lower jaw (16) and anvil (18)) are moving towardsthe closed configuration. Additionally, first angled surface (70640)includes ridges (70642) if desired.

As shown, first housing (70616 a) includes a second angled surface(70644) formed on an opposing side of second cavity (70636). Secondangled surface (70644) extends across gap (G70) adjacent first side(70624) of platform (70618). Second angled surface (70644) is configuredto assist in placement of a first jaw of end effector (70312) adjacentfirst side (70624) of platform (70618). More specifically, second angledsurface (70644) may generally assist in placement of placement tip(70314). Second angled surface (70644) may include ridges (70646).

As shown in FIGS. 106-108B, first buttress assembly (70410) ispositioned on at least proximal portion (70628) of platform (70618).First buttress assembly (70410) is disposed in gap (G70) defined byhousings (70616 a-b). As shown in FIG. 107-108B, second buttressassembly (70412) is positioned on second side (70626) of platform(70618). Additionally, as shown with respect to FIGS. 103-105A, buttressassemblies (70410, 70412) may be provided in a respective pair ofportions that are separated at a distance to avoid spanning across slots(42, 49) to support wide versions of buttress assemblies (70410, 70412)that unitarily span across slots (42, 49) of anvil (18) and staplecartridge (37) referring to instrument (10), respectively.

FIGS. 108A-108B depict an exemplary method of using cartridge (70610) tosecure buttress assemblies (70410, 70412) to end effector (70312). Themethod includes positioning platform (70618) of buttress appliercartridge (70610) between the first and second jaws of end effector(70312), such that buttress assembly (70410) is below anvil (70318) andbuttress assembly (70412) is above the deck of lower jaw (70316), whilefirst and second jaws are in an open configuration. First cavity (70632)accommodates curved distal tip (70314) during such positioning. Themethod also includes driving one or both of the first or second jaws ofend effector (70312) toward platform (70618) to thereby engage buttressassemblies (70410, 70412). As shown in FIG. 108B, as curved distal tip(70314) of end effector (70312) contacts and subsequently deformsagainst first side (70624) of platform (70618) when end effector (70312)moves to the closed configuration, the angle of curved distal tip(70314) changes. The method also includes driving one or both of thefirst or second jaws of end effector (70312) away from platform (70618)to thereby pull buttress assemblies (70410, 70412) off of platform(70618).

2. Another Exemplary Buttress Applier Cartridge

FIGS. 110-111B show another exemplary buttress applier cartridge (70710)Like buttress applier cartridge (70610), buttress applier cartridge(70710) of this example may be used with any end effector (12, 70312,70412) described herein and in any of the various procedures describedin the various patent references cited herein. Buttress appliercartridge (70710) is configured and operable just like buttress appliercartridge (70610), except for the differences indicated below.

Buttress applier cartridge (70710) includes an open end (70712), aclosed end (70714), a first housing (70716 a), a second housing (70716b), a platform (70718), a proximal portion (70720), a distal portion(70722), a first side (70724), a second side (70726), a proximal portion(70728), a distal portion (70730), a first cavity (70732), inner walls(70734), a second cavity (70736), inner walls (70738), a first angledsurface (70740), ridges (70742), a second angled surface (70744), andridges (70746). To this end, like numbers below indicate like featuresdescribed above. Except as otherwise described below, certain details ofbuttress applier cartridge (70710) will therefore be omitted from thefollowing description, it being understood that such details are alreadyprovided above in the description of buttress applier cartridge (70610).Other suitable ways in which various buttress applier cartridges may beused will be apparent to those of ordinary skill in the art in view ofthe teachings herein.

As shown in FIGS. 110-111B, first and second cavities (70732, 70736)connect, and therefore, extend completely through platform (70718). Inother words, first and second cavities (70732, 70736) extend completelythrough first and second sides (70724, 70726) of platform (70718),defining a passageway that passes through the full thickness ofcartridge (70710). First and second cavities (70732, 70736) extendingcompletely therethrough platform (70718) allow placement tip (70314) tomaintain its curved shape and not deform against platform (70718) whenend effector (70312) is in the closed configuration as shown in FIG.111B. Buttress applier cartridge (70710) may thus be used for versionswhere distal tip (219) or placement tip (70314) is rigid; or when it isdesired that distal tip (219) or placement tip (70314) not deflect.

XII. Exemplary Combinations

The following examples relate to various non-exhaustive ways in whichthe teachings herein may be combined or applied. It should be understoodthat the following examples are not intended to restrict the coverage ofany claims that may be presented at any time in this application or insubsequent filings of this application. No disclaimer is intended. Thefollowing examples are being provided for nothing more than merelyillustrative purposes. It is contemplated that the various teachingsherein may be arranged and applied in numerous other ways. It is alsocontemplated that some variations may omit certain features referred toin the below examples. Therefore, none of the aspects or featuresreferred to below should be deemed critical unless otherwise explicitlyindicated as such at a later date by the inventors or by a successor ininterest to the inventors. If any claims are presented in thisapplication or in subsequent filings related to this application thatinclude additional features beyond those referred to below, thoseadditional features shall not be presumed to have been added for anyreason relating to patentability.

EXAMPLE 1

A method of surgical stapling using an apparatus comprising a body, ashaft extending from the body, and an end effector in communication withthe shaft, wherein the method comprises: (a) positioning the endeffector at a desired site for surgical stapling, wherein the endeffector includes: (i) a pair of jaws, (ii) a cartridge configured tohold one or more staples, wherein the cartridge selectively connectswith a first jaw of the pair of jaws, (iii) an anvil configured to becontacted by the one or more staples of the cartridge, wherein a secondjaw of the pair of jaws comprises the anvil, and (iii) a placement tipselected from the group consisting of: (A) a placement tip that iselastically deformable, wherein the placement tip extends distally froma select one of the pair of jaws, wherein the placement tip defines afirst angle with respect to an axis of the select one of the jaws fromwhich the placement tip extends when the end effector is in the openposition, and a second angle with respect the axis of the select one ofthe jaws from which the placement tip extends when the end effector isin a closed position, wherein the second angle differs from the firstangle; (B) a placement tip that is elastically deformable, wherein theplacement tip extends distally from a select one of the pair of jaws,wherein the placement tip comprises a distal end, wherein the placementtip is configured to transition from a first undeflected state to asecond deflected state when the end effector is in the closed positionand loaded, wherein when the placement tip is in the first undeflectedstate the distal end of the placement tip is located proximal to adistal-most end of the jaw opposite to the select one of the jaws fromwhich the placement tip extends, and wherein when the placement tip isin the second deflected state the distal end of the placement tip islocated distal to the distal-most end of the jaw opposite to the selectone of the jaws from which the placement tip extends; (C) a placementtip comprised of a resilient material and extending distally from aselect one of the pair of jaws, wherein the placement tip defines athird longitudinal axis that is oblique relative to a secondlongitudinal axis defined by the first jaw from which the placement tipextends, and wherein the third longitudinal axis defined by theplacement tip extends in a direction towards the second jaw; (D) aplacement tip extending distally from the second jaw, wherein theplacement tip is comprised of a second material, wherein the secondmaterial is resilient, and wherein the placement tip comprises a lowerstiffness than the first jaw; (E) a placement tip that is elasticallydeformable, wherein the placement tip extends distally from the secondjaw, wherein the placement tip comprises an arcuate bend relative to alongitudinal axis of the anvil; (F) a placement tip that is elasticallydeformable and extends distally from a select one of the pair of jaws,wherein the placement tip comprises a pair of sides defining multipledistinct regions that each comprises a width, wherein as the pair ofsides extend distally each width of the distinct regions is smaller thanthe width of the immediate proximally located distinct region; and (G) aplacement tip that is elastically deformable and extends distally fromthe second jaw and distally beyond the cartridge, wherein the placementtip extends in a straight manner along a longitudinal axis defined bythe anvil; (b) controlling one or more of the jaws of the end effectorto place the end effector in an open position, wherein in the openposition a gap exists between the jaws; (c) positioning the endeffector, with the end effector in the open position, such that tissueis located between the jaws; (d) clamping the tissue between the jaws bymoving at least one of the jaws toward the other jaw, wherein clampingthe tissue places the end effector in a loaded state, wherein in theloaded state the placement tip of the second jaw deflects away from thefirst jaw; and (e) advancing a firing beam of the apparatus from aproximal position to a distal position, wherein advancing the firingbeam causes the tissue to be cut by a cutting edge of the firing beam,and wherein advancing the firing beam further causes the tissue to bestapled by ejecting the one or more staples from the cartridge.

EXAMPLE 2

The method of Example 1, wherein the placement tip extends distally fromthe anvil, wherein the first jaw includes an anvil coupled with theplacement tip, wherein the placement tip is configured to contact thestaple cartridge in the closed position, wherein the placement tip isintegrally formed together as a unitary piece, wherein the placement tipis symmetric about the longitudinal axis.

EXAMPLE 3

The method of any one or more of Examples 1 through 2, wherein theplacement tip is elastically deformable, wherein the placement tip iscomprised of a first resilient material, wherein the first jaw fromwhich the placement tip extends is comprised of a second material,wherein the first resilient material has a lower stiffness than thesecond material, wherein the placement tip is configured to deflect inresponse to a clamping force applied to the placement tip.

EXAMPLE 4

The method of any one or more of Examples 1 through 3, wherein theplacement tip is configured such that, when the end effector is in aclosed and unloaded state, the placement tip contacts a portion of thesecond jaw, and wherein when the end effector is in a loaded state withtissue between the first and second jaws, the placement tip deflectsaway from the second jaw, and wherein the placement tip extends distallyfrom the first jaw in a curved manner.

EXAMPLE 5

The method of any one or more of Examples 1 through 4, wherein theplacement tip further comprises a distal end having a profile selectedfrom the group comprising round, angled and pointed, toothed, flared,orb, asymmetric, and combinations thereof, or distal sides defining awidth profile selected from the group comprising angled, stepped,asymmetric, scalloped, bump-out, and combinations thereof.

EXAMPLE 6

The method of any one or more of Examples 1 through 5, wherein the endeffector defines a plurality of zones based on (a) a first plane definedby the distal-most end of the jaw opposite to the select one of the jawsfrom which the placement tip extends, (b) a second plane defined by adeck of the jaw opposite to the select one of the jaws from which theplacement tip extends, wherein the first and second planes areorthogonal to each other, and (c) a third plane defined by a bottomsurface of the jaw opposite to the select one of the jaws from which theplacement tip extends, wherein the third and first plane are orthogonalto each other, and wherein the distal end of the placement tip isconfigured to move from one zone of the plurality of zones when theplacement tip is in the first undeflected state to another zone of theplurality of zones when the placement tip is in the second deflectedstate.

EXAMPLE 7

The method of any one or more of Examples 1 through 6, wherein theplacement tip comprises at least one of a curved longitudinalcross-sectional profile, a multi-angled longitudinal cross-sectionalprofile, a non-rectangular lateral cross-sectional profile, an invertedU-shaped lateral cross-sectional profile, an inverted V-shaped lateralcross-sectional profile, an H-shaped lateral cross-sectional profile, oran oval lateral cross-sectional profile.

EXAMPLE 8

The method of any one or more of Examples 1 through 7, wherein theplacement tip comprises a proximal lateral cross-sectional profile and adistal lateral cross-sectional profile, wherein the proximal lateralcross-sectional profile and the distal lateral cross-sectional profilehave different shapes.

EXAMPLE 9

The method of any one or more of Examples 1 through 8, wherein theplacement tip comprises an arcuate bend relative to a longitudinal axisof the anvil.

EXAMPLE 10

The method of any one or more of Examples 1 through 9, wherein theplacement tip is elastically deformable, and wherein the apparatusfurther comprises a retention feature configured to secure the placementtip with the first jaw, wherein the retention feature is furtherconfigured to prevent removal of the placement tip when the retentionfeature is installed, wherein the retention feature connects a proximalportion of the placement tip with the first jaw, wherein the proximalportion of the placement tip comprises a connection member, wherein theconnection member comprises an opening configured to receive thefastener, and wherein the first jaw comprises a void space having acomplementary shape to the connection member of the placement tip,wherein the first jaw comprises a void space having a complementaryshape to the connection member of the placement tip.

EXAMPLE 11

The method of any one or more of Examples 1 through 10, wherein thefirst jaw comprises a surface feature at a distal end of the first jaw,wherein the surface feature is configured for overmolding attachment ofthe placement tip with the first jaw such that the placement tip extendsdistally from the first jaw, wherein the surface feature of the firstjaw is further configured to prevent detachment of the overmoldedplacement tip, wherein the surface feature of the first jaw is at leastsubstantially surrounded by the overmolded placement tip, wherein thesurface feature is further configured to prevent edge peeling of theovermolded placement tip.

EXAMPLE 12

A method of surgical stapling using an apparatus comprising a body, ashaft extending from the body, and an end effector in communication withthe shaft, wherein the method comprises: (a) positioning the endeffector at a desired site for surgical stapling, wherein the endeffector includes: (i) a pair of jaws, (ii) a cartridge configured tohold one or more staples, wherein the cartridge selectively connectswith a first jaw of the pair of jaws, (iii) an anvil configured to becontacted by the one or more staples of the cartridge, wherein a secondjaw of the pair of jaws comprises the anvil, and (iv) a placement tipselected from the group consisting of: (A) a placement tip located at adistal end of the first jaw or a distal end of the second jaw, whereinthe placement tip comprises: (1) first and second legs extendingdistally from one of the first or second jaws, wherein a void extendscompletely through the placement tip and separates the first and secondlegs, and (2) a distal portion that connects the first and second legs,wherein the distal portion has a first cross-sectional height that isgreater than a second cross-sectional height of the first and secondlegs (B) a placement tip located at a distal end of the first jaw or adistal end of the second jaw, wherein the placement tip includes a bodyportion formed between an outer perimeter and an inner perimeter of theplacement tip, wherein the inner perimeter is defined by a voidextending through the placement tip, and wherein at least a distal endof the body portion is bent towards the opposing jaw; (C) a placementtip extending from a distal end of the first jaw or a distal end of thesecond jaw, wherein the placement tip extends along a curvilinear pathand terminates at a tip end, wherein the placement tip is configuredsuch that successive perimeters of the placement tip taken perpendicularto the curvilinear path decrease moving toward the tip end, and whereinthe tip end extends at a non-zero angle relative to the longitudinalaxis of the end effector (D) a placement tip extending from a distal endof the first jaw or a distal end of the second jaw, wherein theplacement tip comprises: (1) a proximal portion having a proximal tipwidth, and (2) a distal portion having a distal tip width that isgreater than a jaw width of the jaw disposed opposite the placement tip(E) a placement tip extending from a distal end of the first jaw or adistal end of the second jaw, wherein the placement tip includesproximal and distal portions, wherein the distal portion includes anasymmetric profile along the longitudinal axis of the shaft, and whereinthe distal portion includes a tip axis defined by a tip of the distalportion; (F) a placement tip located at a distal end of the first jaw ora distal end of the second jaw, wherein the placement tip includesproximal and distal portions, wherein the distal portion has a distalcross-sectional thickness along a transverse cross-section that isgreater than a proximal cross-sectional thickness of the proximalportion along the transverse cross-section; and (G) a placement tiplocated at a distal end of the first jaw or a distal end of the secondjaw, wherein the placement tip comprises: (1) a proximal portion havinga proximal tip width that is less than a proximal jaw width of the jawdisposed opposite the placement tip, and (2) a distal portion having adistal tip width that is greater than a distal jaw width of the jawdisposed opposite the placement tip; (b) controlling one or more of thejaws of the end effector to place the end effector in an open position,wherein in the open position a gap exists between the jaws; (c)positioning the end effector, with the end effector in the openposition, such that tissue is located between the jaws; (d) clamping thetissue between the jaws by moving at least one of the jaws toward theother jaw, wherein clamping the tissue places the end effector in aloaded state, wherein in the loaded state the placement tip of thesecond jaw deflects away from the first jaw; and (e) advancing a firingbeam of the apparatus from a proximal position to a distal position,wherein advancing the firing beam causes the tissue to be cut by acutting edge of the firing beam, and wherein advancing the firing beamfurther causes the tissue to be stapled by ejecting the one or morestaples from the cartridge.

EXAMPLE 13

The method of any one or more of Examples 1 through 12, furthercomprising a malleable member configured to increase the rigidity of theplacement tip and configured to allow an operator to customize the shapeof the placement tip by producing different placement tip angles,wherein the malleable member includes first and second legs and agenerally U-shaped portion configured to contact the outer perimeter ofthe body portion.

EXAMPLE 14

The method of any one or more of Examples 1 through 13, wherein theplacement tip includes proximal and distal portions, wherein theproximal portion has a proximal tip width that is less than a jaw widthof the jaw disposed opposite the placement tip, and wherein the distalportion has a distal tip width that is greater than the jaw width of thejaw disposed opposite the placement tip.

EXAMPLE 15

The method of any one or more of Examples 1 through 14, furthercomprising an articulation joint coupling the shaft with the endeffector, wherein the articulation joint is configured to enable the endeffector to pivot relative to the shaft, wherein the shaft axis and thetip axis define an angle that is selectively adjustable by a user usingthe articulation joint, wherein the angle is selectively adjustable froman acute angle along a first direction of articulation to an obtuseangle along a second direction of articulation, wherein the seconddirection is opposite the first direction.

EXAMPLE 16

The method of any one or more of Examples 1 through 15, wherein theplacement tip further comprises a central portion disposedlongitudinally between the proximal and distal portions, wherein thecentral portion has a central cross-sectional thickness along thetransverse cross-section that is less than the proximal cross-sectionalthickness and less than the distal cross-sectional thickness or thecentral portion has a central cross-sectional thickness along thetransverse cross-section that is greater than the proximalcross-sectional thickness but less than the distal cross-sectionalthickness.

EXAMPLE 17

The method of any one or more of Examples 1 through 16, furthercomprising securing a buttress assembly to the end effector, thesecuring step further comprises: (i) positioning a platform of abuttress applier cartridge between the first and second jaws while thefirst and second jaws are in an open configuration, wherein the platformhas a buttress disposed thereon; (ii) driving one or both of the firstand second jaws toward the platform to thereby engage the buttressassembly with one of the first and second jaws, wherein a distal portionof the buttress applier cartridge includes a cavity that is sized andshaped to receive a curved distal tip of one of the first or secondjaws, wherein the curved distal tip extends beyond a staple deck of astaple cartridge of the other of first or second jaws when in the closedconfiguration; and (iii) driving one or both of the first or second jawsaway from the platform to thereby pull the buttress assembly off of theplatform.

EXAMPLE 18

The method of any one or more of Examples 1 through 17, wherein thecavity terminates at a planar surface of the platform, wherein thecurved distal tip of the end effector is configured to deform againstthe platform when the end effector is in the closed configuration, orthe cavity extends completely through the platform, wherein the curveddistal tip of the end effector is configured to maintain its curvedshape and not deform against the platform when the end effector is inthe closed configuration such that the curved distal tip is configuredto extend below a staple deck of the opposing staple cartridge of theend effector in the closed configuration.

EXAMPLE 19

The method of any one or more of Examples 1 through 18, wherein the endeffector includes first and second opposing jaws, wherein the first jawincludes the curved distal tip and the second jaw includes a staplecartridge, wherein the distal portion of the housing or the distalportion of the platform includes a first angled surface that isconfigured to be in abutting contact with a distal angled portion of thestaple cartridge, wherein the apparatus is symmetric about a planedefined by the platform, wherein the cavity extends perpendicular to theplatform, and wherein the cavity has a cross-sectional area thatincreases moving towards the platform, and wherein the cavity does notextend across the entire width of the gap.

EXAMPLE 20

A method of operating an instrument, the method comprising: (a) placinga placement tip of a jaw of the instrument between first and secondlayers of tissue that collectively define a tissue opening using only alateral motion, wherein the placement tip is oriented along a tip axisthat is laterally oriented in relation to a longitudinal axis of aproximal portion of the jaw; (b) laterally moving the placement tip ofthe instrument along the tip axis through the tissue opening; (c) andadvancing the placement tip distally through the tissue opening.

XIII Miscellaneous

It should be understood that any one or more of the teachings,expressions, embodiments, examples, etc. described herein may becombined with any one or more of the other teachings, expressions,embodiments, examples, etc. that are described herein. Theabove-described teachings, expressions, embodiments, examples, etc.should therefore not be viewed in isolation relative to each other.Various suitable ways in which the teachings herein may be combined willbe readily apparent to those of ordinary skill in the art in view of theteachings herein. Such modifications and variations are intended to beincluded within the scope of the claims.

It should also be understood that the teachings herein may be readilycombined with various teachings in U.S. patent application Ser. No.29/594,332, entitled “Surgical Stapler End Effector with Varying DeckHeight and Tissue Gripping Features,” filed Feb. 17, 2017, thedisclosure of which is incorporated by reference herein. Varioussuitable ways in which the teachings herein may be combined with theteachings of U.S. patent application Ser. No. 29/594,332, will beapparent to those of ordinary skill in the art.

It should also be understood that the teachings herein may be readilycombined with various teachings in U.S. patent application Ser. No.29/594,335, entitled “Circular Surgical Stapler End Effector withVarying Deck Height and Tissue Gripping Features,” filed Feb. 17, 2017,the disclosure of which is incorporated by reference herein. Varioussuitable ways in which the teachings herein may be combined with theteachings of U.S. patent application Ser. No. 29/594,335 will beapparent to those of ordinary skill in the art.

It should also be understood that the teachings herein may be readilycombined with various teachings in U.S. patent application Ser. No.15/435,607, entitled “Surgical Stapler with Insertable Distal AnvilTip,” filed Feb. 17, 2017, the disclosure of which is incorporated byreference herein. Various suitable ways in which the teachings hereinmay be combined with the teachings of U.S. patent application Ser. No.15/435,607 will be apparent to those of ordinary skill in the art.

It should also be understood that the teachings herein may be readilycombined with various teachings in U.S. patent application Ser. No.15/435,618, entitled “Surgical Stapler with Cooperating Distal TipFeatures on Anvil and Staple Cartridge,” filed Feb. 17, 2017, thedisclosure of which is incorporated by reference herein. Varioussuitable ways in which the teachings herein may be combined with theteachings of U.S. patent application Ser. No. 15/435,618, will beapparent to those of ordinary skill in the art.

It should also be understood that the teachings herein may be readilycombined with various teachings in U.S. patent application Ser. No.29/594,340, entitled “Surgical Stapler with Bent Anvil Tip and AngledStaple Cartridge Tip,” filed Feb. 17, 2017, the disclosure of which isincorporated by reference herein. Various suitable ways in which theteachings herein may be combined with the teachings of U.S. patentapplication Ser. No. 29/594,340, will be apparent to those of ordinaryskill in the art.

It should also be understood that the teachings herein may be readilycombined with various teachings in U.S. patent application Ser. No.15/435,631, entitled “Surgical Stapler with Bent Anvil Tip, AngledStaple Cartridge Tip, and Tissue Gripping Features,” filed Feb. 17,2017, the disclosure of which is incorporated by reference herein.Various suitable ways in which the teachings herein may be combined withthe teachings of U.S. patent application Ser. No. 15/435,631, will beapparent to those of ordinary skill in the art.

It should be appreciated that any patent, publication, or otherdisclosure material, in whole or in part, that is said to beincorporated by reference herein is incorporated herein only to theextent that the incorporated material does not conflict with existingdefinitions, statements, or other disclosure material set forth in thisdisclosure. As such, and to the extent necessary, the disclosure asexplicitly set forth herein supersedes any conflicting materialincorporated herein by reference. Any material, or portion thereof, thatis said to be incorporated by reference herein, but which conflicts withexisting definitions, statements, or other disclosure material set forthherein will only be incorporated to the extent that no conflict arisesbetween that incorporated material and the existing disclosure material.

Versions of the devices described above may have application inconventional medical treatments and procedures conducted by a medicalprofessional, as well as application in robotic-assisted medicaltreatments and procedures. By way of example only, various teachingsherein may be readily incorporated into a robotic surgical system suchas the DAVINCI™ system by Intuitive Surgical, Inc., of Sunnyvale, Calif.Similarly, those of ordinary skill in the art will recognize thatvarious teachings herein may be readily combined with various teachingsof any of the following: U.S. Pat. No. 5,792,135, entitled “ArticulatedSurgical Instrument For Performing Minimally Invasive Surgery WithEnhanced Dexterity and Sensitivity,” issued Aug. 11, 1998, thedisclosure of which is incorporated by reference herein; U.S. Pat. No.5,817,084, entitled “Remote Center Positioning Device with FlexibleDrive,” issued Oct. 6, 1998, the disclosure of which is incorporated byreference herein; U.S. Pat. No. 5,878,193, entitled “Automated EndoscopeSystem for Optimal Positioning,” issued Mar. 2, 1999, the disclosure ofwhich is incorporated by reference herein; U.S. Pat. No. 6,231,565,entitled “Robotic Arm DLUS for Performing Surgical Tasks,” issued May15, 2001, the disclosure of which is incorporated by reference herein;U.S. Pat. No. 6,783,524, entitled “Robotic Surgical Tool with UltrasoundCauterizing and Cutting Instrument,” issued Aug. 31, 2004, thedisclosure of which is incorporated by reference herein; U.S. Pat. No.6,364,888, entitled “Alignment of Master and Slave in a MinimallyInvasive Surgical Apparatus,” issued Apr. 2, 2002, the disclosure ofwhich is incorporated by reference herein; U.S. Pat. No. 7,524,320,entitled “Mechanical Actuator Interface System for Robotic SurgicalTools,” issued Apr. 28, 2009, the disclosure of which is incorporated byreference herein; U.S. Pat. No. 7,691,098, entitled “Platform Link WristMechanism,” issued Apr. 6, 2010, the disclosure of which is incorporatedby reference herein; U.S. Pat. No. 7,806,891, entitled “Repositioningand Reorientation of Master/Slave Relationship in Minimally InvasiveTelesurgery,” issued Oct. 5, 2010, the disclosure of which isincorporated by reference herein; U.S. Pat. No. 8,844,789, entitled“Automated End Effector Component Reloading System for Use with aRobotic System, issued Sep. 30, 2014, the disclosure of which isincorporated by reference herein; U.S. Pat. No. 8,820,605, entitled“Robotically-Controlled Surgical Instrument with Force-FeedbackCapabilities,” issued Sep. 2, 2014, the disclosure of which isincorporated by reference herein; U.S. Pat. No. 8,616,431, entitled“Shiftable Drive Interface for Robotically-Controlled Surgical Tool,”issued Dec. 31, 2013, the disclosure of which is incorporated byreference herein; U.S. Pat. No. 8,573,461, entitled “Surgical StaplingInstruments with Cam-Driven Staple Deployment Arrangements,” issued Nov.5, 2013, the disclosure of which is incorporated by reference herein;U.S. Pat. No. 8,602,288, entitled “Robotically-Controlled MotorizedSurgical End Effector System with Rotary Actuated Closure Systems HavingVariable Actuation Speeds,” issued Dec. 10, 2013, the disclosure ofwhich is incorporated by reference herein; U.S. Pat. No. 9,301,759,entitled “Robotically-Controlled Surgical Instrument with SelectivelyArticulatable End Effector,” issued Apr. 5, 2016, the disclosure ofwhich is incorporated by reference herein; U.S. Pat. No. 8,783,541,entitled “Robotically-Controlled Surgical End Effector System,” issuedJul. 22, 2014, the disclosure of which is incorporated by referenceherein; U.S. Pat. No. 8,479,969, entitled “Drive Interface for OperablyCoupling a Manipulatable Surgical Tool to a Robot,” issued Jul. 9, 2013;U.S. Pat. No. 8,800,838, entitled “Robotically-Controlled Cable-BasedSurgical End Effectors,” issued Aug. 12, 2014, the disclosure of whichis incorporated by reference herein; and/or U.S. Pat. No. 8,573,465,entitled “Robotically-Controlled Surgical End Effector System withRotary Actuated Closure Systems,” issued Nov. 5, 2013, the disclosure ofwhich is incorporated by reference herein.

Versions of the devices described above may be designed to be disposedof after a single use, or they can be designed to be used multipletimes. Versions may, in either or both cases, be reconditioned for reuseafter at least one use. Reconditioning may include any combination ofthe steps of disassembly of the device, followed by cleaning orreplacement of particular pieces, and subsequent reassembly. Inparticular, some versions of the device may be disassembled, and anynumber of the particular pieces or parts of the device may beselectively replaced or removed in any combination. Upon cleaning and/orreplacement of particular parts, some versions of the device may bereassembled for subsequent use either at a reconditioning facility, orby a user immediately prior to a procedure. Those skilled in the artwill appreciate that reconditioning of a device may utilize a variety oftechniques for disassembly, cleaning/replacement, and reassembly. Use ofsuch techniques, and the resulting reconditioned device, are all withinthe scope of the present application.

By way of example only, versions described herein may be sterilizedbefore and/or after a procedure. In one sterilization technique, thedevice is placed in a closed and sealed container, such as a plastic orTYVEK bag. The container and device may then be placed in a field ofradiation that can penetrate the container, such as gamma radiation,x-rays, or high-energy electrons. The radiation may kill bacteria on thedevice and in the container. The sterilized device may then be stored inthe sterile container for later use. A device may also be sterilizedusing any other technique known in the art, including but not limited tobeta or gamma radiation, ethylene oxide, or steam.

Having shown and described various embodiments of the present invention,further adaptations of the methods and systems described herein may beaccomplished by appropriate modifications by one of ordinary skill inthe art without departing from the scope of the present invention.Several of such potential modifications have been mentioned, and otherswill be apparent to those skilled in the art. For instance, theexamples, embodiments, geometrics, materials, dimensions, ratios, steps,and the like discussed above are illustrative and are not required.Accordingly, the scope of the present invention should be considered interms of the following claims and is understood not to be limited to thedetails of structure and operation shown and described in thespecification and drawings.

I/We Claim:
 1. A method of surgical stapling using an apparatuscomprising a body, a shaft extending from the body, and an end effectorin communication with the shaft, wherein the method comprises: (a)positioning the end effector at a desired site for surgical stapling,wherein the end effector includes: (i) a pair of jaws, (ii) a cartridgeconfigured to hold one or more staples, wherein the cartridgeselectively connects with a first jaw of the pair of jaws, (iii) ananvil configured to be contacted by the one or more staples of thecartridge, wherein a second jaw of the pair of jaws comprises the anvil,and (iii) a placement tip selected from the group consisting of: (A) aplacement tip that is elastically deformable, wherein the placement tipextends distally from a select one of the pair of jaws, wherein theplacement tip defines a first angle with respect to an axis of theselect one of the jaws from which the placement tip extends when the endeffector is in the open position, and a second angle with respect theaxis of the select one of the jaws from which the placement tip extendswhen the end effector is in a closed position, wherein the second anglediffers from the first angle; (B) a placement tip that is elasticallydeformable, wherein the placement tip extends distally from a select oneof the pair of jaws, wherein the placement tip comprises a distal end,wherein the placement tip is configured to transition from a firstundeflected state to a second deflected state when the end effector isin the closed position and loaded, wherein when the placement tip is inthe first undeflected state the distal end of the placement tip islocated proximal to a distal-most end of the jaw opposite to the selectone of the jaws from which the placement tip extends, and wherein whenthe placement tip is in the second deflected state the distal end of theplacement tip is located distal to the distal-most end of the jawopposite to the select one of the jaws from which the placement tipextends; (C) a placement tip comprised of a resilient material andextending distally from a select one of the pair of jaws, wherein theplacement tip defines a third longitudinal axis that is oblique relativeto a second longitudinal axis defined by the first jaw from which theplacement tip extends, and wherein the third longitudinal axis definedby the placement tip extends in a direction towards the second jaw; (D)a placement tip extending distally from the second jaw, wherein theplacement tip is comprised of a second material, wherein the secondmaterial is resilient, and wherein the placement tip comprises a lowerstiffness than the first jaw; (E) a placement tip that is elasticallydeformable, wherein the placement tip extends distally from the secondjaw, wherein the placement tip comprises an arcuate bend relative to alongitudinal axis of the anvil; (F) a placement tip that is elasticallydeformable and extends distally from a select one of the pair of jaws,wherein the placement tip comprises a pair of sides defining multipledistinct regions that each comprises a width, wherein as the pair ofsides extend distally each width of the distinct regions is smaller thanthe width of the immediate proximally located distinct region; and (G) aplacement tip that is elastically deformable and extends distally fromthe second jaw and distally beyond the cartridge, wherein the placementtip extends in a straight manner along a longitudinal axis defined bythe anvil; (b) controlling one or more of the jaws of the end effectorto place the end effector in an open position, wherein in the openposition a gap exists between the jaws; (c) positioning the endeffector, with the end effector in the open position, such that tissueis located between the jaws; (d) clamping the tissue between the jaws bymoving at least one of the jaws toward the other jaw, wherein clampingthe tissue places the end effector in a loaded state, wherein in theloaded state the placement tip of the second jaw deflects away from thefirst jaw; and (e) advancing a firing beam of the apparatus from aproximal position to a distal position, wherein advancing the firingbeam causes the tissue to be cut by a cutting edge of the firing beam,and wherein advancing the firing beam further causes the tissue to bestapled by ejecting the one or more staples from the cartridge.
 2. Themethod of claim 1, wherein the placement tip extends distally from theanvil, wherein the first jaw includes an anvil coupled with theplacement tip, wherein the placement tip is configured to contact thestaple cartridge in the closed position, wherein the placement tip isintegrally formed together as a unitary piece, wherein the placement tipis symmetric about the longitudinal axis.
 3. The method of claim 1,wherein the placement tip is elastically deformable, wherein theplacement tip is comprised of a first resilient material, wherein thefirst jaw from which the placement tip extends is comprised of a secondmaterial, wherein the first resilient material has a lower stiffnessthan the second material, wherein the placement tip is configured todeflect in response to a clamping force applied to the placement tip. 4.The method of claim 1, wherein the placement tip is configured suchthat, when the end effector is in a closed and unloaded state, theplacement tip contacts a portion of the second jaw, and wherein when theend effector is in a loaded state with tissue between the first andsecond jaws, the placement tip deflects away from the second jaw, andwherein the placement tip extends distally from the first jaw in acurved manner.
 5. The method of claim 1, wherein the placement tipfurther comprises a distal end having a profile selected from the groupcomprising round, angled and pointed, toothed, flared, orb, asymmetric,and combinations thereof, or distal sides defining a width profileselected from the group comprising angled, stepped, asymmetric,scalloped, bump-out, and combinations thereof.
 6. The method of claim 1,wherein the end effector defines a plurality of zones based on (a) afirst plane defined by the distal-most end of the jaw opposite to theselect one of the jaws from which the placement tip extends, (b) asecond plane defined by a deck of the jaw opposite to the select one ofthe jaws from which the placement tip extends, wherein the first andsecond planes are orthogonal to each other, and (c) a third planedefined by a bottom surface of the jaw opposite to the select one of thejaws from which the placement tip extends, wherein the third and firstplane are orthogonal to each other, and wherein the distal end of theplacement tip is configured to move from one zone of the plurality ofzones when the placement tip is in the first undeflected state toanother zone of the plurality of zones when the placement tip is in thesecond deflected state.
 7. The method of claim 1, wherein the placementtip comprises at least one of a curved longitudinal cross-sectionalprofile, a multi-angled longitudinal cross-sectional profile, anon-rectangular lateral cross-sectional profile, an inverted U-shapedlateral cross-sectional profile, an inverted V-shaped lateralcross-sectional profile, an H-shaped lateral cross-sectional profile, oran oval lateral cross-sectional profile.
 8. The method of claim 1,wherein the placement tip comprises a proximal lateral cross-sectionalprofile and a distal lateral cross-sectional profile, wherein theproximal lateral cross-sectional profile and the distal lateralcross-sectional profile have different shapes.
 9. The method of claim 1,wherein the placement tip comprises an arcuate bend relative to alongitudinal axis of the anvil.
 10. The method of claim 1, wherein theplacement tip is elastically deformable, and wherein the apparatusfurther comprises a retention feature configured to secure the placementtip with the first jaw, wherein the retention feature is furtherconfigured to prevent removal of the placement tip when the retentionfeature is installed, wherein the retention feature connects a proximalportion of the placement tip with the first jaw, wherein the proximalportion of the placement tip comprises a connection member, wherein theconnection member comprises an opening configured to receive thefastener, and wherein the first jaw comprises a void space having acomplementary shape to the connection member of the placement tip,wherein the first jaw comprises a void space having a complementaryshape to the connection member of the placement tip.
 11. The method ofclaim 1, wherein the first jaw comprises a surface feature at a distalend of the first jaw, wherein the surface feature is configured forovermolding attachment of the placement tip with the first jaw such thatthe placement tip extends distally from the first jaw, wherein thesurface feature of the first jaw is further configured to preventdetachment of the overmolded placement tip, wherein the surface featureof the first jaw is at least substantially surrounded by the overmoldedplacement tip, wherein the surface feature is further configured toprevent edge peeling of the overmolded placement tip.
 12. A method ofsurgical stapling using an apparatus comprising a body, a shaftextending from the body, and an end effector in communication with theshaft, wherein the method comprises: (a) positioning the end effector ata desired site for surgical stapling, wherein the end effector includes:(i) a pair of jaws, (ii) a cartridge configured to hold one or morestaples, wherein the cartridge selectively connects with a first jaw ofthe pair of jaws, (iii) an anvil configured to be contacted by the oneor more staples of the cartridge, wherein a second jaw of the pair ofjaws comprises the anvil, and (iv) a placement tip selected from thegroup consisting of: (A) a placement tip located at a distal end of thefirst jaw or a distal end of the second jaw, wherein the placement tipcomprises: (1) first and second legs extending distally from one of thefirst or second jaws, wherein a void extends completely through theplacement tip and separates the first and second legs, and (2) a distalportion that connects the first and second legs, wherein the distalportion has a first cross-sectional height that is greater than a secondcross-sectional height of the first and second legs (B) a placement tiplocated at a distal end of the first jaw or a distal end of the secondjaw, wherein the placement tip includes a body portion formed between anouter perimeter and an inner perimeter of the placement tip, wherein theinner perimeter is defined by a void extending through the placementtip, and wherein at least a distal end of the body portion is benttowards the opposing jaw; (C) a placement tip extending from a distalend of the first jaw or a distal end of the second jaw, wherein theplacement tip extends along a curvilinear path and terminates at a tipend, wherein the placement tip is configured such that successiveperimeters of the placement tip taken perpendicular to the curvilinearpath decrease moving toward the tip end, and wherein the tip end extendsat a non-zero angle relative to the longitudinal axis of the endeffector (D) a placement tip extending from a distal end of the firstjaw or a distal end of the second jaw, wherein the placement tipcomprises: (1) a proximal portion having a proximal tip width, and (2) adistal portion having a distal tip width that is greater than a jawwidth of the jaw disposed opposite the placement tip (E) a placement tipextending from a distal end of the first jaw or a distal end of thesecond jaw, wherein the placement tip includes proximal and distalportions, wherein the distal portion includes an asymmetric profilealong the longitudinal axis of the shaft, and wherein the distal portionincludes a tip axis defined by a tip of the distal portion; (F) aplacement tip located at a distal end of the first jaw or a distal endof the second jaw, wherein the placement tip includes proximal anddistal portions, wherein the distal portion has a distal cross-sectionalthickness along a transverse cross-section that is greater than aproximal cross-sectional thickness of the proximal portion along thetransverse cross-section; and (G) a placement tip located at a distalend of the first jaw or a distal end of the second jaw, wherein theplacement tip comprises: (1) a proximal portion having a proximal tipwidth that is less than a proximal jaw width of the jaw disposedopposite the placement tip, and (2) a distal portion having a distal tipwidth that is greater than a distal jaw width of the jaw disposedopposite the placement tip; (b) controlling one or more of the jaws ofthe end effector to place the end effector in an open position, whereinin the open position a gap exists between the jaws; (c) positioning theend effector, with the end effector in the open position, such thattissue is located between the jaws; (d) clamping the tissue between thejaws by moving at least one of the jaws toward the other jaw, whereinclamping the tissue places the end effector in a loaded state, whereinin the loaded state the placement tip of the second jaw deflects awayfrom the first jaw; and (e) advancing a firing beam of the apparatusfrom a proximal position to a distal position, wherein advancing thefiring beam causes the tissue to be cut by a cutting edge of the firingbeam, and wherein advancing the firing beam further causes the tissue tobe stapled by ejecting the one or more staples from the cartridge. 13.The method of claim 12, further comprising a malleable member configuredto increase the rigidity of the placement tip and configured to allow anoperator to customize the shape of the placement tip by producingdifferent placement tip angles, wherein the malleable member includesfirst and second legs and a generally U-shaped portion configured tocontact the outer perimeter of the body portion.
 14. The method of claim12, wherein the placement tip includes proximal and distal portions,wherein the proximal portion has a proximal tip width that is less thana jaw width of the jaw disposed opposite the placement tip, and whereinthe distal portion has a distal tip width that is greater than the jawwidth of the jaw disposed opposite the placement tip.
 15. The method ofclaim 12, further comprising an articulation joint coupling the shaftwith the end effector, wherein the articulation joint is configured toenable the end effector to pivot relative to the shaft, wherein theshaft axis and the tip axis define an angle that is selectivelyadjustable by a user using the articulation joint, wherein the angle isselectively adjustable from an acute angle along a first direction ofarticulation to an obtuse angle along a second direction ofarticulation, wherein the second direction is opposite the firstdirection.
 16. The method of claim 12, wherein the placement tip furthercomprises a central portion disposed longitudinally between the proximaland distal portions, wherein the central portion has a centralcross-sectional thickness along the transverse cross-section that isless than the proximal cross-sectional thickness and less than thedistal cross-sectional thickness or the central portion has a centralcross-sectional thickness along the transverse cross-section that isgreater than the proximal cross-sectional thickness but less than thedistal cross-sectional thickness.
 17. The method of claim 12, furthercomprising securing a buttress assembly to the end effector, thesecuring step further comprises: (i) positioning a platform of abuttress applier cartridge between the first and second jaws while thefirst and second jaws are in an open configuration, wherein the platformhas a buttress disposed thereon, (ii) driving one or both of the firstand second jaws toward the platform to thereby engage the buttressassembly with one of the first and second jaws, wherein a distal portionof the buttress applier cartridge includes a cavity that is sized andshaped to receive a curved distal tip of one of the first or secondjaws, wherein the curved distal tip extends beyond a staple deck of astaple cartridge of the other of first or second jaws when in the closedconfiguration, and (iii) driving one or both of the first or second jawsaway from the platform to thereby pull the buttress assembly off of theplatform.
 18. The method of claim 17, wherein the cavity terminates at aplanar surface of the platform, wherein the curved distal tip of the endeffector is configured to deform against the platform when the endeffector is in the closed configuration, or the cavity extendscompletely through the platform, wherein the curved distal tip of theend effector is configured to maintain its curved shape and not deformagainst the platform when the end effector is in the closedconfiguration such that the curved distal tip is configured to extendbelow a staple deck of the opposing staple cartridge of the end effectorin the closed configuration.
 19. The method of claim 18, wherein the endeffector includes first and second opposing jaws, wherein the first jawincludes the curved distal tip and the second jaw includes a staplecartridge, wherein the distal portion of the housing or the distalportion of the platform includes a first angled surface that isconfigured to be in abutting contact with a distal angled portion of thestaple cartridge, wherein the apparatus is symmetric about a planedefined by the platform, wherein the cavity extends perpendicular to theplatform, and wherein the cavity has a cross-sectional area thatincreases moving towards the platform, and wherein the cavity does notextend across the entire width of the gap.
 20. A method of operating aninstrument, the method comprising: (a) placing a placement tip of a jawof the instrument between first and second layers of tissue thatcollectively define a tissue opening using only a lateral motion,wherein the placement tip is oriented along a tip axis that is laterallyoriented in relation to a longitudinal axis of a proximal portion of thejaw; (b) laterally moving the placement tip of the instrument along thetip axis through the tissue opening; and (c) and advancing the placementtip distally through the tissue opening.